Outpatient hyperhidrosis treatment by non-intubated uniportal VATS sympathectomy

Fortunately, there are effective treatment options 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 thoracic surgery, excessive sweating can be specifically stopped “at the root.” In the following, we will explain in layman’s terms what hyperhidrosis is, what treatments are available, and how this novel operation works. We also share fictional 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 itself is a normal and important bodily function for temperature regulation. In 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 nerve stimulation. The autonomic nervous system – more precisely, the sympathetic part – sends excessive signals to sweat, without any cooling being necessary. 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, is the result of an underlying cause, such as hormonal changes (e.g., during menopause), hyperthyroidism, diabetes, certain medications, or other diseases. In such cases, treatment is primarily aimed at the underlying disease – a specific sweat 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 should be sought (e.g., hormonal disorders or infections). In the far more common 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 exists. It has been observed that in hyperhidrosis patients, the sympathetic ganglia (clusters of nerve cells of the sympathetic nervous system) may be enlarged – 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 moist hands make everyday situations difficult – from shaking hands to holding a pen or smartphone. Clothing is constantly soaked, which can be particularly embarrassing in professional life. Many patients report social withdrawal, insecurity in their appearance, and even psychological burdens 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 adolescents with severely sweaty hands avoid touching and are ashamed in front of classmates. Working people fear the “sweaty handshake” during the job interview. Everyday situations such as opening a door (wet hands slip on 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 been suffering from sweaty hands since puberty. Even with slight stress or even in quiet moments, sweat dripped from his palms. During his studies, he found it difficult to hand out paper without leaving stains. In the job interview, he avoided shaking hands for fear of the reaction of his counterpart. “I constantly had moist 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 an online search, he came across the DayKlinik in Berlin and its specialized hyperhidrosis consultation. After a detailed consultation, Max decided on sympathectomy in Non-intubated uniportal VATS technique. The procedure was quick and without general anesthesia. Still in the recovery room, Max noticed in amazement: 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 can bring successful treatment. Before we go into the novel surgical method, let’s take a look at the usual treatment options for heavy 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: First, a high-dose antiperspirant with aluminum chloride is usually used. Such Sweat blocker in the form of lotion or roll-on are applied to the dry skin in the evening (e.g., of the armpits or palms). Aluminum chloride narrows and clogs the sweat gland ducts, which often significantly reduces sweating. With regular use (initially several nights in a row, then as needed), mild cases can be well controlled. However, skin irritation can occur, and in very severe hyperhidrosis, topicals reach their limits.
• Iontophoresis: Especially for Hand and foot sweating sometimes a tap water iontophoresis helps. 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 as a result. 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 drives the sweat glands. This can systemically reduce sweat production. However, the Side effects often limiting: dry mouth, palpitations, visual disturbances, or constipation can occur. Therefore, tablets are usually only used for very pronounced hyperhidrosis or when local therapies fail.
• Botox injections: An established approach, especially for armpit hyperhidrosisare injections with botulinum toxin (Botox). The nerve poison 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) with fine needles. Within one to two weeks, the amount of sweat is significantly reduced. The effect lasts on average 6-9 months, then it must be retreated. Botox is also effective for palms, but painful during injection and not entirely unproblematic due to the dense nerve supply of the hands (temporary muscle weakness 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 by targeted heat exposure. Surgical procedures directly on the affected area – such as Suctioning or scraping out underarm sweat glands (suction curettage) – can also be considered. These methods can help in selected cases, but are sometimes only suitable for certain regions (MiraDry only armpits) or carry the risk that the sweat glands will partially regenerate.

All these conservative measures can bring relief. Many patients find a 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” means the surgical transection or elimination of a section of the sympathetic trunk – that 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 corresponding 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 their quality of life after the surgery. No wonder, then, that sympathectomy is now considered a 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 usually do not grow back together). The step therefore wants to be well 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 relevant section of the nerve strand – depending on the location of the sweating at the level of T2, T3 or T4 of the thoracic spine – is identified and electrically severed 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 about 30–60 minutes (correspondingly longer for bilateral surgery). The surgeon then re-inflates the lung, places a drain if necessary, and wakes the patient up. Patients usually stay in the 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 find it mild, but some may in turn be affected by it. In most cases, compensatory sweating settles down within a few months or improves on its own. An important is a thorough clarification before the surgery: patients need to know that while they will get rid of the original sweating problem, there is a certain residual risk of increased sweating in another part of 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 have surgery. In addition to compensatory sweating, are Operational risks as with any procedure, but rare: no deaths have been recorded in experienced centers. There can 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 (drooping eyelid and pupillary constriction due to damage to the cervical sympathetic nerve). The latter is extremely rare (under 1%) due to precise surgical technique (sparing 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 method, which 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 surgery, i.e. keyhole surgery in the chest with the help of a camera. This is the technique we have already described for conventional sympathectomy – minimally invasive procedures through small accesses.
• 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 hidden 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 more minimal access trauma. Uniportal VATS is a further development of thoracic surgery that has become established in recent years for some operations.
• Non-intubated means translated “not intubated”i.e. without a breathing tube under general anesthesia. Specifically, this means: 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 general anesthesia. 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 intubation, no 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. That means: To the clinic in the morning, home again at midday/evening – without an overnight stay in the hospital. This is ideal, especially for otherwise healthy people who are often young. You save yourself a longer downtime and the hospital environment, can recover faster in the familiar home and are back in everyday life more quickly. Last but not least, this also reduces costs (no inpatient costs, less material required), which relieves the healthcare system – for patients in Germany, the health insurance companies usually cover the costs if the indication is secured (see FAQ on cost coverage).

Experts emphasize that the non-intubated technique is just as safe and effective is like the conventional method. In direct comparisons, one found 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 comfortable faster (no heavy awakening from anesthesia). The quality of the results (permanently dry hands/armpits) is identical in the long term. Thoracic surgeons even see sympathectomy as ideal intervention to apply the non-intubated procedure, because it is comparatively short and technically not very stressful. The number of centers worldwide that use 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: First, as with any hyperhidrosis surgery, a thorough consultation and examination takes place. It is important that a Primary hyperhidrosis is present and conservative therapies are exhausted or insufficient. On the day of the surgery, the patient comes to the outpatient DayClinic. There he is accompanied by a experienced anesthesia team who provide the sedation and local anesthesia takes over. Usually, the patient receives calming and pain-relieving medication via a vein (comparable to twilight sleep, similar to a gastroscopy, only a little 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, the arms carefully angled so that the lateral chest 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 are used to create visibility. Here, gravity and negative pressure help: By opening the chest cavity, the lung collapses. The anesthesiologist can also provoke a certain pause in breathing by administering targeted medication or ensure that the lung is as calm 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 looks for the sympathetic borderline. on the inner chest wall area. Depending on the treatment goal, now – usually at the level of the 2nd or 3rd rib – the nerve strand is severed or a clip is placed on it. Often on both sides operated on (because hyperhidrosis affects both sides of the body symmetrically). This can be done in the same session: After completing the first side, the patient is repositioned a little for the second side, and the same procedure is performed there analogously.

The actual operation step often only takes a few minutes per side. After the transection, the surgeon sometimes directly tests the effect (for hand sweating, for example, the temperature of the hand can be measured, which immediately rises and the palm becomes dry and warm). The lungs are then unfolded again. In many cases, a prophylactic a thin drainage tube for a few minutes through the same skin incision to be able to suck out any remaining air. Still in the operating room or immediately afterwards, a X-ray is made to ensure that no significant pneumothorax has remained and that the lung is fully inflated. If everything is in order, the tiny drain is removed and the skin 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 feel quite fit after just one to two hours. After about 2-4 hours of monitoring can usually allow discharge on the same day take place. The patients get a light pressure bandage over the plaster bandage and are allowed to go home accompanied. Important: For the day of the surgery, you should not actively participate in road traffic yourself (because of the sedation). At home, patients can rest; the pain is usually low – often a normal pain tablet is sufficient or even none at all, as only the small incision can pull a little. Many are surprised how Few complaints occur after such a “chest surgery.” This is due to the minimally invasive technique and the avoidance of rib spreading or large incisions.

The very next day most people feel one thing above all: Your problem area stays dry. The hands no longer sweat, armpits remain largely dry even in stressful situations. The small wound heals in a few days, after a week the thread can be pulled (if not self-dissolving) – the incision is so small that often hardly a visible scar remains. After 1–2 weeks, most can exercise without restrictions again and shower normally, etc. Office work or light work is often possible again after just a few days. The exact recovery period is 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 moist shortly after showering. In meetings in the office, she almost only wore black or white so that sweat stains were less noticeable. Often she had to change shirts or work with pads under her armpits. “I was constantly afraid that someone might notice the smell or the stains,” says Sabine. After special deodorants and even a Botox treatment brought only limited improvement, she informed herself about permanent solutions. Her dermatologist mentioned the possibility of a sympathectomy. Through a research Sabine found the Special hyperhidrosis consultation at the VenaZiel DayKlinik Berlin. There, the new method without general anesthesia was explained to her. 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 lease on life,” says Sabine today. “I act completely differently since I no longer have to worry about sweat stains.”

This report is encouraging: Outpatient sympathectomy can help especially working people who have suffered from the restrictions so far. In the next section, we will answer 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 heat, sports or stress – this is normal and important for cooling. In 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 the hands, even though it is cool and one is sitting there 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 occurring at night during sleep. It often starts 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 sweating. Odor-binding insoles and regular barefoot walking help against foot sweating. If this is not sufficient, consult specialist medical advice – there are 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 at VenaZiel 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 surgery is, so to speak, the last resort – but a very effective one. Typical candidates are patients who are 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 minimally invasive techniques. 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 gentler: no ventilation tube, fewer accesses, less postoperative pain. In addition, this method can often be performed on an outpatient basis, while general anesthesia usually required a short inpatient stay. In summary: Same goal (sever the nerve), but with a more modern, patient-friendly approach.

Does one notice anything during the surgery? Does that hurt?

No – you will not nothing of the actual operation. Due to the sedation, you are in a sleep-like state. In addition, the affected areas are locally anesthetizedso that no pain will be felt. Some patients are theoretically “awake” but so relaxed that they don’t remember anything afterward. You don’t have to be afraid of waking up on the operating table or feeling pain. The anesthesia team monitors you the whole time. Some patients report that they briefly felt some pressure or an unusual feeling when the lungs were inflated – but this is always announced beforehand and is not painful. Overall, the experience is comparable to 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 consequences (you often don’t notice it, except on the X-ray). In rare cases, a larger pneumothorax would have to be treated with a drainage. Horner syndrome (see above) is extremely rare (<1%) and practically excluded by careful surgical technique. In short: The procedure has been performed for decades, and the outpatient variant has proven to be just as safe. It is important that you are in a 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 – so the body tries to ensure temperature regulation in other ways. The frequency is given differently 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 disturbing, is fortunately less common (approx. 5–10% of patients). In many cases, it is temporary or decreases again in the months after the surgery. Important to know: Compensatory sweating mainly affects the torso and legs, not the hands or feet (which remain dry). Despite this phenomenon, most patients are satisfied with their decision, as the relief from dry hands/armpits outweighs it. In our consultation, we always discuss this topic in detail 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 inconspicuous in a natural skin fold (e.g., lateral axillary fold). In many patients, this small scar is 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 a significant extent. In large studies, No relapses observed, which suggested a regrowth of the nerves. There are rare reports from patients in whom slight sweating started again years later – but this is usually because Neighboring nerve tracts can partially take over (so-called Kuntz nerves). Good surgeons therefore cauterize small additional fibers if necessary to prevent this. Overall, you can expect the treated areas (e.g., hands) to remain significantly drier than before for a lifetime. There is no “decrease” in 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 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. Here, higher ganglia (T2) are often interrupted. Many affected people 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 minimally increased, depending on how close to the stellate ganglion one operates. For pronounced head sweating (e.g., forehead), sympathectomy can also bring relief, 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 health insurance companies require this as proof. In a consultation, we can discuss the procedure individually.

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

You can contact our hyperhidrosis consultation in Berlin. In our center – the VenaZiel DayClinic by VenaZiel – we have specialists for outpatient thoracic surgery. Simply arrange an appointment by phone or online. In this initial consultation, we will record 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 support you organizationally (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 is also very high for axillary hyperhidrosis, although in rare cases a minimal residual sweat may remain – but usually far from the original amount. Patient satisfaction in studies is >90%. Most only regret not having had the procedure done sooner. But a realistic expectation is important: complete no one will be sweat-free all over the body, because that shouldn’t be the goal – 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 is, you won’t be out of action for long. As a rule, patients are already at home after 1–2 days Fit again for light everyday activities. Office work is often possible after just a few days. After a week, we will remove any stitches, and from then on you will usually be fully resilient. You should pause physically strenuous jobs or sports for about 1–2 weeks to give your body time to heal. Many report that they recovered much faster than expected – precisely because no general anesthesia 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 lung self-breathing would be difficult for them during the surgery. Very strong Overweight can also make the method more difficult, as the respiratory reserve is lower here – such cases are assessed individually. Also patients who absolutely want to sleep or are very anxious can of course still be operated on under general anesthesia – the non-intubated method is an offer, not a must. Overall, however, it has been shown that the ideal conditions for most hyperhidrosis patients bring with them: They are often young, slim and healthy apart from sweating, so that the procedure is very feasible. Your surgeon and anesthetist will clarify all risks in advance. If non-intubated is not possible, sympathectomy can of course still be performed in the classic way under general anesthesia.

Is sympathectomy really the last step?

Basically yes – the sympathectomy is a final solution for focal sweating on hands/armpits. It should be well considered and decided together with you if other measures have not brought the desired success. After all, it is an operation, and even if it is minimally invasive, it remains an invasive step. However, most patients who come to us have already had a long history of suffering and various therapies behind them. 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 the hospital. We take the time to answer all questions (as in this FAQ) and help you make the right decision for yourself.

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 to “put 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 of life within a few hours. Thorough education and individual consultation are important. Our VenaZiel DayClinic in Berlin (VenaZiel) has specialized in this innovative procedure and is at the side of those affected with expertise. 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 Diakonie. (Primary vs. secondary hyperhidrosis, causes)
3. McConaghy JR, Fosselman D. Hyperhidrosis: Management Options. Am Fam Physician. 2018;97(11):729-734. (Therapy recommendation, conservative measures, importance 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. (Effectiveness 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)