Outpatient hyperhidrosis treatment by non-intubated uniportal VATS sympathectomy

Fortunately, effective treatment options are available today. Especially in Berlin, Potsdam and Brandenburg now has an innovative therapy is now available that without general anesthesia and without hospitalization hospitalization: the non-intubated uniportal VATS sympathectomy. This Minimally invasive, outpatient procedures of thoracic surgery can specifically stop excessive sweating “at the root”. Below, we explain in layman’s terms what hyperhidrosis is, what treatments are available and how this new type of surgery works. We also share fictitious patient experiences from Berlin and the surrounding area and answer frequently asked questions (FAQ) on the subject.

What is hyperhidrosis (excessive sweating)?

Hyperhidrosis means that the body’s the body’s sweat production exceeds the required level is increased. Sweating in itself is a normal and important bodily function for temperature regulation. With hyperhidrosis, however, this regulation becomes unbalanced: the body produces sweat, although cooling would not be necessary. Typically, certain parts of the body are particularly affected: most frequently the palms, armpits, soles of the feet or the face. People with hyperhidrosis do not have more sweat glands than others – rather, the existing sweat glands are Overactive sweat glands due to excessive nervous stimulation. The autonomic nervous system – more precisely the sympathetic part – gives excessive signals for sweating without the need for cooling. Primary hyperhidrosis (idiopathic) often begins in adolescence, occurs symmetrically on the “favorite spots” (e.g. both hands or both armpits at the same time) and is not caused by other not caused by other diseases. Secondary hyperhidrosis On the other hand, sweating is the result of an underlying cause, such as hormonal changes (e.g. during the menopause), hyperthyroidism, diabetes, certain medications or other illnesses. In such cases, treatment is primarily aimed at the underlying disease – a specific sweating treatment such as sympathectomy is then usually not used.

Important: If excessive sweating suddenly occurs in adulthood or is accompanied by other symptoms, you should always look for another possible cause. other cause (e.g. hormonal disorders or infections). With the far more frequent primary hyperhidrosis on the other hand, there are no such causes – this is an independent disease in which the sweat regulation is set “to the stop”. is. The exact mechanisms are not yet fully understood, but it is assumed that a Dysregulation in the sympathetic nervous system is present. For example, it has been observed that the sympathetic ganglia (accumulations of nerve cells of the sympathetic nervous system) can be enlarged in hyperhidrosis patients – an indication that the problem is not the sweat glands themselvesbut their excessive nervous activation.

Quality of life and suffering from excessive sweating

For outsiders, heavy sweating may seem like a “cosmetic” problem, but for those affected, the impairment of quality of life often enormous. Permanently wet hands make everyday situations more difficult – from shaking hands to holding a pen or smartphone. Clothing is constantly soaked, which can be particularly embarrassing at work. Many patients report social withdrawal, insecurity in their appearance and even psychological stress such as anxiety disorders or depression as a result of hyperhidrosis. An important point: hyperhidrosis is not life-threateningbut it affects Education, career and private life negative. Even teenagers with very sweaty hands avoid touching them and feel embarrassed in front of their classmates. Professionals fear the “sweaty handshake” at a job interview. Everyday situations such as opening a door (wet hands slip off the handle) or wearing colorful clothing (fear of visible sweat stains) become a daily challenge.

Patient report: Max from Berlin – Dry hands at last
Max (26) from Berlin had suffered from sweaty hands since puberty. Sweat dripped from his palms even when he was slightly stressed or in quiet moments. At university, he found it difficult to hand out paper without leaving stains. At job interviews, he avoided shaking hands for fear of the other person’s reaction. “I always had wet tissues in my pocket to wipe my hands,” reports Max. He tried special antiperspirants and even tablets from the dermatologist – unfortunately without resounding success. Through online research, he came across the DayKlinik in Berlin and its specialized hyperhidrosis consultation. After a detailed consultation, Max decided to have a sympathectomy in Non-intubated uniportal VATS technique. The procedure went quickly and without general anesthesia. Max was still amazed in the recovery room: his hands were warm and dry. Today, a few months after the operation, he reports: “It’s incredible – I can finally shake hands without fear. My self-confidence has improved dramatically.”

This fictional experience report is an example of how much of a burden hyperhidrosis can be – and the dramatic improvement a successful treatment can bring. Before we discuss the new surgical method, let’s take a look at the usual treatment options for severe sweating.

Conservative treatment options: Stopping sweating without surgery?

Hyperhidrosis therapy is carried out in stages. Depending on the severity and the area of the body affected, various conservative (non-surgical) methods are possible:

• Special antiperspirants: The first step is usually to use a high-dose antiperspirant with aluminum chloride. Such Sweat blocker in the form of lotion or roll-on are applied to dry skin (e.g. armpits or palms) in the evening. Aluminum chloride constricts and blocks the sweat gland ducts, which often significantly reduces sweating. With regular use (initially several nights in a row, then as required), mild cases can be well controlled. However, skin irritation can occur and topicals reach their limits in cases of very severe hyperhidrosis.
• Iontophoresis: Especially for Hand and foot sweating tap water iontophoresis can sometimes help. The hands or feet are placed in a conductive water bath and a weak direct current is passed through them. Several sessions per week can “calm” the sweat glands. The exact mechanism of action is unclear, but many patients achieve at least temporary improvement. However, the method requires some Attention and regular useto remain effective.
• Drug treatment: Tablets against sweating usually contain anticholinergics (e.g. the active ingredient glycopyrronium or oxybutynin). These inhibit the effect of the neurotransmitter acetylcholine, which stimulates the sweat glands. This can reduce sweat production systemically. However, the Side effects often limiting: dry mouth, palpitations, visual disturbances or constipation can occur. Tablets are therefore usually only used for very severe hyperhidrosis or if local therapies fail.
• Botox injections: An established approach, especially for armpit hyperhidrosisare injections with botulinum toxin (Botox). The neurotoxin temporarily blocks the transmission of stimuli to the sweat glands. The treatment is carried out on an outpatient basis by a dermatologist: diluted Botox is injected into the affected skin (e.g. the armpit) using fine needles. Within one to two weeks, the amount of sweat is significantly reduced. The effect lasts on average 6-9 monthsBotox is also effective for the palms. Botox is also effective for the palms of the hands, although it is painful to inject and not entirely unproblematic due to the dense nerve supply to the hands (temporary muscle weaknesses can occur). Botox is also relatively cost-intensive and is sometimes only reimbursed by health insurance companies for hyperhidrosis after approval.
• Modern procedures: In recent years, new local therapy methods have been developed, e.g. microwave therapy (“MiraDry”) for armpits, in which sweat glands are destroyed through the targeted application of heat. Surgical procedures directly on the affected area – such as the Suctioning or scraping out underarm sweat glands (suction curettage) – can be considered. These methods can help in selected cases, but are sometimes only suitable for certain regions (MiraDry only armpits) or entail the risk of the sweat glands partially regenerating.

All these conservative measures can bring relief. Many patients find sufficient improvement in their symptoms as a result. But: In severe cases – for example, if the hands continue to drip despite everything or the level of suffering is enormous – these treatments are sometimes not enough. In addition, some therapies are only temporarily effective (Botox, iontophoresis) or involve regular visits to the doctor. At the latest when conservative methods have been exhausted and hyperhidrosis continues to dominate everyday life, the question of a permanent solution arises. This is where the surgical approach comes into play: cutting or eliminating the responsible sympathetic nerves. sympathetic nerves in the chest that control sweating.

Sympathectomy – when nothing else helps?

The endoscopic thoracic sympathectomy (ETS) is considered most effective and permanently effective treatment of primary hyperhidrosis, especially in cases of severe hand hand sweating and underarm perspiration. “Sympathectomy” refers to the surgical severing or elimination of a section of the sympathetic nerve trunk – the nerve plexus that runs parallel to the spine in the chest and controls the sweat glands. This measure interrupts the overactive nerve transmission and sweating stops in the relevant areas (e.g. hands, armpits, face). The success rate is very high: studies show a immediate “healing rate” of around 95 % – almost almost all patients have dry hands immediately after the procedure. dry hands. The Satisfaction rate is excellent at over 90 %. Many report a dramatic improvement in quality of life after the operation. It is therefore no wonder that sympathectomy for severe hyperhidrosis is now regarded as the standard therapy in therapy-resistant cases is considered – however traditionally only if all gentler methods have really failed. This is partly because it is a surgical procedure with potential risks and partly because the effect is irreversible (the nerves do not usually grow back together). The step must therefore be carefully considered.

How does a sympathectomy work? Since the 1990s, sympathectomy has been performed minimally invasively using Chest endoscopy (thoracoscopy). A camera and fine surgical instruments are inserted between the ribs via small incisions (usually 2-3 per side). The affected section of the nerve cord – depending on the localization of the sweating at the level of T2, T3 or T4 of the thoracic spine – is identified and cut electrically or interrupted with titanium clips. The operation is traditionally performed in General anesthesia with one-sided lung ventilation (the lung on the side to be operated on is collapsed to create space). The procedure itself often only takes around 30-60 minutes (longer if both sides are operated on). The surgeon then unfolds the lung again, places a drain if necessary and wakes the patient up. Patients usually remain in hospital for 1-2 days for monitoring. The Chances of success are excellent: the hands (or treated area) are immediately dry and warm postoperatively – a sign that the sympathetic impulse has been interrupted.

The downside of the sympathectomy is the possible compensatory sweatingBecause the body can no longer sweat on the hands/armpits, it reflexively increases sweat production in other areas (e.g. on the back, stomach or legs), especially when it is very hot. This Evasive sweating occurs in varying degrees – many patients hardly notice it or experience it as mild, but some may be affected by it. In most cases, compensatory sweating settles down within a few months or improves on its own. It is important to thorough clarification before surgery: Patients need to know that although they will get rid of the original sweating problem, there is a certain residual risk of increased sweating elsewhere on the body. Nevertheless, surveys and studies show that the Large majority of those operated on are satisfied with the result and does not regret the decision to undergo surgery. In addition to the compensatory sweating Operational risks as with any procedure, but are rare: No deaths have been recorded in experienced centers. There may be small Pneumothoraces (accumulation of air in the chest), which usually remain without consequences, very rarely lead to nerve irritation or – if too much air is cut – to a Horner’s syndrome (eyelid drooping and pupil constriction due to damage to the sympathetic cervical nerve). The latter is extremely rare (less than 1 %) thanks to precise surgical technique (protection of ganglion T1).

Overall, thoracoscopic sympathectomy is a fast, effective and quick, effective and safe procedure with a high success rate. Until recently, however, it required always require general anesthesia and hospitalization. This is where the new development comes in, which is particularly interesting for patients in Berlin and the surrounding area: the Outpatient, non-intubated uniportal sympathectomy.

Modern innovation: Non-intubated uniportal VATS sympathectomy (outpatient)

Under the somewhat unwieldy term “non-intubated uniportal VATS sympathectomy” hides a state-of-the-art surgical methodwhich makes the procedure described above even gentler. Let’s break down the term:

• VATS stands for Video-Assisted Thoracoscopic Surgerywhich stands for video-assisted thoracoscopic surgerykeyhole surgery in the chest using a camera. This is the technique we have already described for conventional sympathectomy – minimally invasive surgery through small access points.
• Uniportal means that the entire procedure is through a single small incision takes place. Instead of two or three separate accesses, the surgeon only uses a single incision (approx. 1.5 cm long, usually concealed in the lateral thoracic wall/armpit), through which both the camera and the instruments are inserted. The advantage: fewer potential sources of pain, only one scar, even less access trauma. Uniportal VATS is a further development in thoracic surgery that has become established in recent years for a number of operations.
• Non-intubated means translated “not intubated”i.e. without a breathing tube under general anesthesia. In concrete terms, this means that the operation is without general anesthesia and without artificial respiration carried out. The patient must not intubated and connected to an anesthesia machine, but breathes spontaneously on its own during the procedure. spontaneously independently. Instead, a different anesthetic procedure is used, e.g. a combination of local anesthesia (local anesthesia or regional anesthesia) and light sedation. sedation (twilight sleep). The patient is in a relaxed, pain-free state, but is not as deeply unconscious as with a general anesthetic. This is also referred to as a “awake” thoracic surgery (where patients are typically asleep or unaware of the operation, but without intubation).

What are the specific benefits of this innovation for patients? Several advantagesFirstly, the stresses and strains of general anesthesia are eliminated – i.e. the risk of breathing tube intubationno artificial ventilation with possible after-effects on the lungs, and fewer side effects such as less nausea or sore throat postoperatively. Studies show that with non-intubated VATS procedures fewer postoperative complications such as pneumonia (lung inflammation) occur and patients recover more quickly. On the other hand, the combination of uniportal and non-intubated allows such a gentle procedure that many patients can be treated on an outpatient basis can be realized. This means: To the clinic in the morning, home again at midday/evening – without an overnight stay in hospital. This is particularly ideal for otherwise healthy patients, who are often young. They are spared a longer period of absence and the hospital environment, can recover more quickly in their familiar home and are back in their everyday lives more quickly. Last but not least, this also reduces costs (no inpatient costs, less material required), which relieves the burden on the healthcare system – for patients in Germany, health insurance companies generally cover the costs if the indication is confirmed (see FAQ on cost coverage).

Experts emphasize that the non-intubated technique is just as safe and effective is the same as the conventional method. In direct comparisons No disadvantages in terms of success rate of sweat reduction or complication rate. On the contrary: the Satisfaction immediately after the operation is often higher because patients feel more comfortable more quickly (no difficult awakening from anesthesia). The quality of the results (permanently dry hands/underarms) is identical in the long term. Thoracic surgeons even consider sympathectomy to be ideal intervention to apply the non-intubated procedurebecause it is comparatively short and less technically demanding. The number of centers around the world using this technique is therefore increasing – and Berlin is one of the pioneers in Germanywhere this method is already being offered to selected patients.

How does a non-intubated sympathectomy work?

Preparation: As with any hyperhidrosis operation, the first step is a thorough consultation and examination. It is important that Primary hyperhidrosis conservative therapies have been exhausted or are inadequate. On the day of surgery, the patient comes to the outpatient clinic on an empty stomach. DayClinic. There he is accompanied by a experienced anesthesia team who provide the sedation and local anesthesia takes over. The patient is usually given sedative and pain-relieving medication via a vein (comparable to a twilight sleep, similar to a gastroscopy, only slightly stronger). In addition, the Nerve pathways in the surgical area are anesthetizedfor example by local injection of local anesthetic into the intercostal spaces concerned or by a so-called intercostal nerve block. Sometimes the anesthetist also uses a Laryngeal mask (a mask in the throat, no intubation) to secure the airway and slightly support breathing – however, the patient is not However, the patient does not receive muscle paralyzing ventilation, but usually breathes spontaneously.

Implementation: If the sedation is sufficient and the surgical area is insensitive to pain, the surgeon begins the procedure. The patient is placed in a supine position with their arms gently bent so that the side of the breast is accessible. A small incision (approx. 1-2 cm) is made in the lateral thoracic wall is made, often in the axillary line, through which the thoracoscope (camera) and instruments are inserted (uniportal). Now comes an interesting aspect: since there is no one-sided ventilation, the lungs of the side undergoing the procedure must be made to shrink differently to create visibility. Gravity and negative pressure help here: the opening of the chest cavity causes the lungs to collapse. The anesthetist can also provoke a certain breathing pause by administering specific medication or ensure that the lungs are as quiet as possible with very gentle ventilation. In some centers, a targeted Vagus nerve block (with local anesthesia) is used to suppress the urge to cough. As soon as the field of vision is clear, the surgeon searches the inner chest wall area for the sympathetic borderline. This is well protected above the rib heads. Depending on the treatment objective – usually at the level of the 2nd or 3rd rib – the nerve cord is severed or a clip is applied. Often on both sides (because the hyperhidrosis affects both sides of the body symmetrically). This can be done in the same session: Once the first side has been completed, the patient is repositioned slightly for the second side and the same procedure is performed there.

The actual operation step often only takes a few minutes per side. After cutting, the surgeon sometimes tests the effect directly (e.g. if the hand is sweating, the temperature of the hand can be measured, which rises immediately and the palm becomes dry and warm). The lungs are then expanded again. In many cases, a prophylactic a thin drainage tube for a few minutes through the same incision in order to remove any remaining air. While still in the operating theater or immediately afterwards, a X-ray to ensure that no significant pneumothorax remains and that the lung is fully expanded. If everything is OK, the tiny drainage tube is removed and the incision is closed with a few self-dissolving stitches.

Follow-up and discharge: The patient recovers briefly in the recovery room. Thanks to the lack of general anesthesia, the Significantly shorter recovery times – Many people feel quite fit after just one or two hours. After about 2-4 hours of monitoring can usually allow discharge on the same day take place. Patients are given a light pressure bandage over the plaster bandage and are allowed to go home with an escort. Important: For the day of the operation, patients should not actively participate in road traffic (due to sedation). Patients can rest at home; the pain is usually low – A normal painkiller is often sufficient, or even none at all, as only the small incision can cause some pain. Many people are surprised at how Few complaints occur after such a “rib cage operation”. This is due to the minimally invasive technique and the absence of rib spreading or large incisions.

The very next day most people feel one thing above all: Your problem area stays dry. Hands no longer sweat, armpits remain largely dry even in stressful situations. The small wound heals in a few days and the stitches can be removed after a week (if they are not self-dissolving) – the incision is so small that there is often hardly any visible scarring. After 1-2 weeks, most people can resume unrestricted sporting activities and shower normally etc. Office work or light work is often possible again after just a few days. The exact recovery period will be clarified by the treating doctor, but in general the Healing process very short compared to classic operations.

Patient report: Sabine from Potsdam – Appear confidently without sweat stains
Sabine (34) from Potsdam suffered above all from heavy underarm perspiration. Her armpits felt damp shortly after showering. In meetings at the office, she almost only wore black or white so that sweat marks were less noticeable. She often had to change shirts or work with pads under her armpits. “I was constantly afraid that someone would notice the smell or the stains,” Sabine explains. After special deodorants and even a Botox treatment only brought limited improvement, she looked into permanent solutions. Her dermatologist mentioned the possibility of a sympathectomy. Through research, Sabine found the Special hyperhidrosis consultation at the VenaZiel DayKlinik Berlin. The new method without general anesthesia was explained to her there. Sabine gained confidence and decided to have the procedure. The effect was amazing: The day after the operation, she was able to wear a colorful, tight T-shirt for the first time – and it stayed dry. and it stayed dry. “It’s a new attitude to life,” says Sabine today. “I have a completely different appearance since I no longer have to worry about sweat stains.”

This report is encouraging: outpatient sympathectomy can help working people in particular who have previously suffered from the restrictions. In the next section, we answer the following questions Frequently asked questions (FAQ) about hyperhidrosis and treatment – from risks and success rates to cost coverage.

Frequently asked questions (FAQ)

What is the difference between normal sweating and hyperhidrosis?

Everyone sweats in the heat, during sport or stress – this is normal and important for cooling down. With a Hyperhidrosis However, those affected sweat without a corresponding trigger, in excessive amounts and often on certain parts of the body. For example, beads of sweat run down your hands even though it is cool and you are sitting relaxed. Hyperhidrosis is diagnosed when for at least 6 months excessive, uncontrollable sweating occurs, which on both sides and symmetrical occurs in typical areas (hands, armpits, feet, face) without appearing at night during sleep. It often begins in adolescence. Normal sweating, on the other hand, is linked to the circumstances and stops as soon as the trigger is over.

Which parts of the body are most commonly affected?

Most commonly we see focal hyperhidrosis on the palms (palmar) and armpits (axillary). Also common is excessive Sweating of the soles of the feet (plantar) and facial and head sweating (craniofacial). Some patients also have combinations – e.g. hands and feet, or hands and armpits at the same time. Generalized hyperhidrosis of the entire body is rarer (this is often secondary, i.e. caused by other causes). Primary hyperhidrosis occurs symmetrically on both sides on both sides – e.g. both hands equally – and has favorite areaswhile other areas sweat normally.

What can I do myself against heavy sweating?

Simple measures should be tried first: Antiperspirant deodorants with aluminum chloride from the pharmacy can help with armpits, hands or feet, applied before going to bed. Wear clothing made of breathable natural fibers to allow sweat to evaporate better. In stressful moments, relaxation techniques (autogenic training, yoga) can help, as emotional stress often triggers outbreaks of perspiration. Odor-absorbing soles and regular barefoot walking can help against foot perspiration. If this is not enough, wear specialist medical advice There are also various non-surgical therapies such as medication, tap water iontophoresis or Botox injections (see above). The dermatologist or specialized hyperhidrosis centers (such as our consultation in Berlin) can advise you on this.

When should I consider a sympathectomy?

A sympathectomy may be considered if severe, focal sweating is present (e.g. dripping hands or massively wet armpits) and all conservative measures do not provide sufficient improvement have brought. The OP is, so to speak, the last resort – but a very effective one. Typical candidates are patients who, due to their hyperhidrosis are considerably restricted in everyday life (e.g. unable to work, severe psychological stress) and for whom Botox every 6 months, for example, is not a permanent solution or was ineffective. It is important that other causes have been ruled out (in the case of secondary hyperhidrosis, the underlying disease would be treated instead of a sympathectomy). If you are unsure, seek advice from a specialist consultation – the benefits and risks can be weighed up together.

How does non-intubated sympathectomy differ from the classic method with general anesthesia?

The actual surgical step in the chest is the same: the severing of the sympathetic nerve cord using a minimally invasive technique. The difference lies in the Type of anesthesia and accessIn the classic method, you will be given a general anesthetic, intubated and artificially ventilated, and the procedure is usually performed via 2-3 small incisions (bi- or multi-portal thoracoscopy). With the non-intubated uniportal VATS on the other hand avoids intubation – So you do not receive deep general anesthesia, but only sedation and local anesthesia – and the surgeon works only via a single mini-access. This makes the surgery gentlerNo breathing tube, fewer accesses, less post-operative pain. In addition, this method can often be performed on an outpatient basis, whereas general anesthesia usually requires a short inpatient stay. To summarize: Same goal (cutting the nerve), but with a more modern, patient-friendly procedure.

Do you notice anything during the operation? Does it hurt?

No – you will not nothing of the actual operation. The sedation puts you in a sleep-like state. In addition, the affected areas are locally anesthetizedso that no pain can be felt. Some patients are theoretically “awake”, but are so relaxed that they don’t remember anything afterwards. You do not have to be afraid of waking up on the operating table or feeling pain. The anesthesia team will monitor you the whole time. Some patients report briefly feeling a little pressure or an unfamiliar sensation when their lungs are inflated – but this is always announced in advance and is not painful. Overall, for most people the experience is comparable to having a pleasant twilight sleepfrom which you wake up relatively fresh without nausea.

How safe is the operation?

In experienced hands, thoracoscopic sympathectomy is a very safe very safe procedure. Serious complications are very rare. In large case series with hundreds of patients, there were no deaths and practically no irreversible damage. Of course, as with any procedure, general risks can occur (post-operative bleeding, infection of the wound, very rare injury to structures in the chest). Specific risks include pneumothorax (air in the chest). Small pneumothoraces occur relatively frequently, but usually heal without any consequences (they are often not even noticed, except on X-ray). In rare cases, a larger pneumothorax may need to be treated with a drain. Horner syndrome (see above) is extremely rare (<1 %) and practically impossible thanks to careful surgical technique. In short: The procedure has been performed for decades, and the outpatient variant has proven to be just as safe. The important thing is that you specialized center where thoracic surgeons and anesthesiologists have experience with the method – as in our facility in Berlin.

What exactly is compensatory sweating and how often does it occur?

Compensatory sweating is the name given to evasive sweating in other parts of the body after a sympathectomy. Because certain sweat glands (e.g. in the hands and armpits) have been “shut down”, the body sometimes reacts with increased sweating on the back, stomach, thighs etc., especially during physical activity or heat. It is assumed that this is a thermoregulatory mechanism The body tries to ensure temperature regulation in other ways. The frequency varies depending on the study. Mild compensatory sweating occurs relatively frequently perhaps in a third to half of patients. Strongly pronounced Compensatory sweating, which is perceived as really annoying, is fortunately rarer (approx. 5-10% of patients). In many cases, it is temporary or decreases again in the months following the operation. Important to know: Compensatory sweating mainly affects the trunk and legs, not the hands or feet (they remain dry). Despite this phenomenon, most patients are satisfied with their decision, as the relief of dry hands/shoulders outweighs the discomfort. We always discuss this topic in detail during our consultation so that you can make an informed decision.

Do scars remain after uniportal VATS sympathectomy?
Only a tiny scar per side, about 1-2 cm long, remains – often inconspicuously positioned in a natural skin fold (e.g. lateral axillary fold). In many patients, this small scar is visible after a few months. barely visible. As there are no large incisions or even openings in the chest, you do not have to worry about disfiguring scars.

Can the sweating come back at some point after the operation?

As a rule, the result is permanent. The severed nerve fibers regenerate not to any significant extent. In large studies No relapses were observed, which indicated that the nerves had regrown. There are rare reports of patients who started sweating again years later – but this is usually due to the fact that Neighboring nerve tracts can partially take over (so-called Kuntz nerves). Good surgeons therefore cauterize small additional fibres if necessary to prevent this. Overall, you can expect the treated areas (e.g. hands) to remain significantly drier than before for the rest of your life. There is no “wearing off” of the effect as with Botox.

Does sympathectomy also help against foot sweating?

Sympathectomy in the chest mainly affects sweating in the upper part of the body. upper part of the body – i.e. hands, armpits, face. Foot sweating (plantar hyperhidrosis) is controlled by nerves in the lumbar region. A thoracic sympathectomy has the following effects no direct effect. In some studies, a minimal improvement was observed when hands were affected at the same time, but in general, a different intervention would be necessary for isolated foot sweating, namely a Lumbar sympathectomy. However, this is a much more extensive procedure and is rarely performed, as foot sweating is often treated with conservative methods or Botox, for example. However, many patients with combined hand and foot sweating find the treatment of the hands alone to be a great relief. For purely plantar hyperhidrosis, we will be happy to advise you on conservative options.

Can the surgery also treat facial redness or blushing?

Yes, thoracic sympathectomy has in fact also been used in patients with severe blushing (facial blushing) or facial sweating. This often interrupts higher ganglia (T2). Many patients report a positive effect – less blushing or drier facial skin. However, this is an individual decision and should be discussed in detail with the surgeon, as in these cases the risk of Horner’s syndrome may be slightly increased the closer the operation is performed to the stellate ganglion. Sympathectomy can also provide relief for pronounced head sweating (e.g. forehead), as the upper thoracic ganglia are also responsible for this.

Does health insurance cover the costs of hyperhidrosis surgery?

If there is a medical necessity i.e. diagnosed severe hyperhidrosis that has been treated conservatively, the statutory health insurance companies generally cover the costs of sympathectomy. It is a recognized procedure for this indication. Our clinic (VenaZiel MVZ, DayKlinik Berlin) will support you with the application process and provide the necessary findings and expert reports. Those with private insurance should clarify in advance whether the costs will be covered, but usually have no problems as it is an established treatment. It is important that beforehand other therapies have been tried – some insurance companies require this as proof. We can discuss the procedure individually in a consultation.

How can I get an appointment for a consultation in Berlin?

You can contact our hyperhidrosis consultation in Berlin. In our center – the DayClinic by VenaZiel – we have specialists for outpatient thoracic surgery. Simply make an appointment by telephone or online. During this initial consultation, we will take your medical history, advise you on all options (surgical and non-surgical) and, if necessary, carry out initial examinations. Together we will find out whether non-intubated sympathectomy is suitable for you. Of course, we are also available to patients from the surrounding area (Brandenburg and neighboring federal states) – a further journey may be worthwhile for this specialized treatment, as only a few centers offer the non-intubated VATS technique. If required, we can also provide you with organizational support (e.g. bundling appointments on one day to avoid multiple trips).

What are the overall prospects of success?

The chances of success of a correctly performed sympathectomy with the right indication are excellent. Almost 100 % of patients with palmar hyperhidrosis (hand sweating) achieve dryness immediately after the procedure. The success rate for axillary hyperhidrosis is also very high, although in rare cases a minimal amount of residual sweat may remain – although this is usually far from the original amount. Patient satisfaction is 90% in studies >. Most only regret not having undergone the procedure earlier. However, it is important to have realistic expectations: complete Nobody will become sweat-free all over their body, because that is not the aim – the body still needs temperature regulation. But the pathological, uncontrolled sweating in the problem areas will disappearand self-confidence and quality of life will return.

How long will I be out of action after the procedure?

The fact that it is an outpatient, minimally invasive procedure you will not be out of action for long. As a rule, patients are back home after 1-2 days. Fit again for light everyday activities. Office work is often possible after a few days. After a week, we will remove any stitches and from then on you will usually be able to work at full capacity. You should take a break from physically strenuous jobs or sport for around 1-2 weeks to give your body time to heal. Many people report that they have recovered much faster than expected – precisely because no general anesthetic was necessary and only tiny incisions were made.

For whom is non-intubated sympathectomy not suitable?

There are a few exclusion criteria. Patients with severe lung diseases or pronounced adhesions in the chest (e.g. after previous tuberculosis or major lung surgery) may not be candidates, as they would find it difficult to breathe through their lungs during surgery. Very strong Overweight can also make the method more difficult, as the breathing reserve is lower here – such cases are assessed individually. Patients who absolutely want to sleep or are very anxious, it is of course still possible to operate under general anesthesia – the non-intubated method is an option, not a must. Overall, however, it has been shown that the ideal conditions for most hyperhidrosis patients bring with them: You are often young, slim and healthy apart from sweating, so the procedure is very feasible. Your surgeon and anesthetist will clarify all risks in advance. If non-intubated surgery is not possible, the sympathectomy can of course still be performed under general anesthesia in the traditional way.

Is sympathectomy really the last step?

Basically yes – the sympathectomy is a final solution for focal sweating of the hands/underarms. It should be carefully considered and decided together with you if other measures have not produced the desired results. After all, it is an operation, and even if it is minimally invasive, it is still an invasive step. However, most patients who come to us have already suffered for a long time and have undergone various therapies. If the sweating is so severe that it dominates life, then this procedure is often the step towards a new life. Thanks to the new methods (outpatient, without general anesthesia), the hurdle is now lower – you no longer have to spend days in hospital. We take the time to answer all your questions (as in this FAQ) and help you make the right decision for you.

Conclusion

Excessive sweating can have a massive impact on quality of life – but sufferers in Berlin, Potsdam and the surrounding area don’t have to put up with it. The modern sympathectomy using the non-intubated uniportal VATS technique offers a gentle, outpatient solution to permanently “Putting an end to sweating. Thanks to minimally invasive thoracic surgery without general anesthesia, patients can go from dripping wet hands or armpits to a dry, liberated feeling within a few hours. It is important to provide thorough information and individual advice. Our DayClinic in Berlin (VenaZiel) specializes in this innovative procedure and is on hand to provide expertise to those affected. With a success rate of ~95% and high patient satisfaction rates, sympathectomy is a proven option for severe hyperhidrosis when conservative therapies fail. No more embarrassing sweat stains – use the new possibilities of outpatient thoracic surgery to go through life without a care in the world again.

References

1. Brackenrich J, Medeus CF. Hyperhidrosis. StatPearls, 2022 (Definition, prevalence and effects of hyperhidrosis)
2. Ev. Waldkrankenhaus Spandau – Hyperhidrosis. Johannesstift Deaconry. (Primary vs. secondary hyperhidrosis, causes)
3. McConaghy JR, Fosselman D. Hyperhidrosis: Management Options. Am Fam Physician. 2018;97(11):729-734. (Treatment recommendation, conservative measures, value of sympathectomy)
4. Dereli Y. et al. Bilateral thoracoscopic sympathectomy for primary hyperhidrosis: a review of 335 cases. Clinics (Sao Paulo). 2013;68(7):1018-1023. (Efficacy of sympathectomy, success rates, complications)
5. Elia S. et al. Awake one-stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis: a safe outpatient procedure. Eur J Cardiothorac Surg. 2005;28(2):312-317. (Comparison of local anesthesia vs. general anesthesia, outpatient feasibility)
6. Haessig T. et al. NiVATS sympathectomy for hyperhidrosis: should I stay or should I go? Video-Assisted Thoracic Surgery. 2021. (Narrative review of non-intubated VATS sympathectomy, advantages and results)
7. Zhang K. et al. Non-intubated vs. intubated VATS for thoracic disease: a meta-analysis of 1,684 cases. J Thorac Dis. 2019. (Meta-analysis – fewer complications and shorter stay with NiVATS)
8. Mineo TC. et al. Thoracoscopic sympathectomy under local anesthesia versus general anesthesia: a study in primary hyperhidrosis. Ann Thorac Surg. 1999;67(3):965-968. (Earlier study on the feasibility of sympathectomy without GA)