{"id":20535,"date":"2025-08-01T04:22:05","date_gmt":"2025-08-01T04:22:05","guid":{"rendered":"https:\/\/venaziel.de\/thoracic-surgery\/excessive-sweating-hyperhidrosis-causes-treatment-and-sympathectomy\/"},"modified":"2026-04-06T11:18:14","modified_gmt":"2026-04-06T11:18:14","slug":"uebermaessiges-schwitzen-hyperhidrose","status":"publish","type":"page","link":"https:\/\/venaziel.de\/en\/thoraxchirurgie\/uebermaessiges-schwitzen-hyperhidrose\/","title":{"rendered":"Excessive sweating (hyperhidrosis) – causes, treatment and sympathectomy"},"content":{"rendered":"

This article explains clearly why hyperhidrosis occurs, which <\/span>treatment options<\/b> are available and why a <\/span>thoracoscopic sympathectomy<\/b> – especially in <\/span>uniportal VATS technique<\/b> and even <\/span>without intubation<\/b> – can be an effective, final solution. Finally, we answer frequently asked questions (FAQ). <\/span>Dr. Hamidreza Mahoozi<\/span><\/i> (specialist in thoracic surgery, Berlin) provides an insight into this modern therapy, which can be <\/span>outpatient<\/b> can be carried out on an outpatient basis.<\/span><\/p>\n

Causes and forms of hyperhidrosis<\/b><\/h2>\n

A distinction is made between <\/span>primary (idiopathic)<\/b> from <\/span>secondary (symptomatic)<\/b> Hyperhidrosis. With the <\/span>primary hyperhidrosis<\/b> there are no other underlying diseases – the sweat glands are healthy in themselves, but sweat regulation is overactive. The exact causes are not yet fully understood.<\/span><\/p>\n

It is suspected that a <\/span>hypersensitivity of the sympathetic nervous system<\/b> is present, so that even <\/span>slightest stimuli<\/b> (such as <\/span>stress, excitement or heat<\/b>) trigger excessive sweating. <\/span> <\/p>\n

This form is often <\/span>focal<\/b>and therefore affects certain regions: e.g. <\/span>palmar<\/b> (palms), <\/span>axillary<\/b> (armpits), <\/span>plantar<\/b> (soles of the feet) or <\/span>craniofacial<\/b> (face\/head). There is often a <\/span>familial predisposition<\/b>and the symptoms usually begin during <\/span>puberty or in young adulthood<\/b>.<\/span><\/p>\n

In contrast, secondary hyperhidrosis occurs as a result of other diseases or triggers. For example, hormonal disorders (e.g. hyperthyroidism, menopause), metabolic diseases (diabetes), infections, neurological diseases or certain medications can cause heavy sweating. <\/span><\/p>\n

In such cases, treatment is directed at the underlying disease, as sweating is usually only a symptom. Generalized hyperhidrosis (affecting the whole body) also often has secondary causes, while <\/span>Primary hyperhidrosis<\/b> typically <\/span>locally limited<\/b> (e.g. only hands and armpits).<\/span><\/p>\n

Effects on quality of life<\/b><\/h2>\n

Excessive sweating is <\/span>not a danger to life<\/b>However, it places an enormous burden on those affected in everyday life. The constant moisture on the hands or body leads to <\/span>social insecurity<\/b> – many avoid shaking hands, close physical contact or public situations for fear of embarrassing sweat stains. <\/span> <\/p>\n

At work<\/b> Hyperhidrosis can also cause problems: Damp hands make it difficult to handle paper, instruments or electronic devices; some patients choose their profession based on where sweating is less of a hindrance. <\/span> <\/p>\n

Studies show that about <\/span>50 % of patients<\/b> restrict their <\/span>restrict their lifestyle<\/b> and constantly have the feeling that the disease is “taking over”. Almost <\/span>70 %<\/b> report <\/span>chronic worry, anxiety or depression<\/b> through sweating. Up to <\/span>48 %<\/b> rate their <\/span>quality of life<\/b> as poor or very poor – comparable to severe chronic skin diseases.<\/span><\/p>\n

The psychological stress can in turn create a <\/span>vicious circle<\/b> Stress and excitement increase sweating, which leads to further stress. <\/span> <\/p>\n

Many sufferers are reluctant to seek medical help out of shame or because they are not aware that <\/span>Hyperhidrosis is treatable<\/b> is. Today, there are effective therapies that can improve quality of life. <\/span>significantly improve<\/b> – from simple local measures to the final operational solution, which we will discuss below.<\/span><\/p>\n

Conservative treatment methods (without surgery)<\/b><\/h2>\n

Non-surgical therapies<\/b> are always at the beginning of the treatment. They can often achieve good results for mild to moderate hyperhidrosis:<\/span><\/p>\n

    \n
  • Antiperspirants (aluminum chloride)<\/b>Special antiperspirants <\/span>deodorants, ointments or solutions<\/b> with aluminum chloride are <\/span>the first choice<\/b> for e.g. axillary hyperhidrosis. <\/span>
    \n<\/span>They <\/span>clog<\/b> temporarily the ducts of the sweat glands. Regular use (especially at night) can significantly reduce sweat production. Disadvantage: Skin irritation and often not sufficiently effective with heavy sweating.<\/span> <\/li>\n
  • Iontophoresis<\/b>For <\/span>palmar or plantar hyperhidrosis<\/b> the <\/span>tap water iontophoresis<\/b> as <\/span>therapy standard<\/b>. The hands or feet are immersed in conductive water and <\/span>Light electrical currents<\/b> through it. Over time, this leads to a <\/span>Inhibition of sweat gland activity<\/b>. Initially, it must be applied several times a week, later approx. once a week for maintenance. Many patients achieve a noticeable reduction in sweating, but the method requires a lot of effort. <\/span>Discipline and time commitment<\/b>.<\/span> <\/li>\n
  • Botulinum toxin injections (Botox)<\/b>Botulinum toxin A blocks the nerve impulses. <\/span>nerve impulses<\/b> at the sweat glands and can therefore almost completely stop sweat production locally. <\/span>
    \n<\/span>Especially for <\/span>axillary hyperhidrosis<\/b> This treatment is successfully used on the hands, but it can also be effective on the palms or forehead. The procedure must be repeated every few months, as the effect on average <\/span>4-9 months<\/b> stops. Botox treatment is relatively uncomplicated and effective for the armpits; it is also effective on the palms of the hands, but painful due to the many injections (a local anesthetic can help here). Botulinum toxin is a <\/span>Proven method<\/b> with <\/span>highly effective<\/b>but costly in the long term and limited in time.<\/span> <\/li>\n
  • Systemic medication<\/b>: <\/span>Anticholinergics<\/b> (such as glycopyrronium bromide or oxybutynin) can reduce sweat secretion throughout the body. They block the neurotransmitter <\/span>acetylcholine<\/b>which activates the sweat glands. <\/span>
    \n<\/span>However, these drugs are often associated with <\/span>side effects<\/b> dry mouth, palpitations, visual disturbances or constipation – which limits their long-term use. Also <\/span>herbal sedatives<\/b> or <\/span>sedatives<\/b> have been tried, as stress increases sweating, but their effect is usually minimal.<\/span> <\/li>\n
  • Local surgical procedures<\/b>For <\/span>axillary hyperhidrosis<\/b> there are procedures such as <\/span>sweat gland curettage<\/b> or <\/span>liposuction<\/b> (suction\/scraping of the sweat glands in the armpits). <\/span>
    \n<\/span>These can significantly reduce the amount of sweat in the armpits, but are only considered once the above conservative methods have been exhausted. You are <\/span>local interventions<\/span><\/i> and avoid severing the nerve, but they only help in the armpit and not with sweating in the hands or other regions.<\/span> <\/li>\n<\/ul>\n

    Despite these options, the <\/span>final cure<\/b> of primary hyperhidrosis is difficult. Many measures only work <\/span>Temporary<\/b> or incomplete. If a patient suffers from persistently severe, therapy-refractory sweating and their quality of life is severely restricted, the next step is to treat them. <\/span>last option<\/b> surgical intervention can be considered: the <\/span>thoracoscopic sympathectomy<\/b>. <\/span> <\/p>\n

    This should only be done after <\/span>all conservative options have been exhausted<\/b> Despite minimally invasive techniques, this is an invasive step with possible side effects. We examine this operation in detail in the next section.<\/span><\/p>\n

    Thoracic sympathectomy – the final solution<\/b><\/h2>\n

    The <\/span>thoracic sympathectomy<\/b> (also known as <\/span>Endoscopic thoracic sympathectomy<\/b> – <\/span>ETS<\/span><\/i> – called) is currently the <\/span>only method<\/b>to permanently cure primary focal hyperhidrosis <\/span>permanently<\/b>. Part of the <\/span>sympathetic nervous system<\/b> in the chest, which controls the overactive sweat glands, is severed or blocked. The aim of this intervention is to <\/span>excessive nerve impulses<\/b> to the sweat glands so that the affected areas (e.g. hands or armpits) are permanently dry. <\/span>permanently dry<\/span><\/i> remain dry.<\/span><\/p>\n

     <\/p>\n

    How does it work?<\/b> The sympathetic border cord runs along both sides of the spinal column within the rib cage. It contains several <\/span>Ganglia (nerve nodes)<\/b>from which nerve fibers run to the sweat glands of the face, hands, armpits, etc. Depending on the area affected, the transection must be made at a certain level. <\/span>height<\/b> can take place. <\/span> <\/p>\n

     <\/p>\n

    For <\/span>sweaty hands (palmar)<\/b> typically the <\/span>3rd thoracic ganglion (T3)<\/b> is cut; for <\/span>sweating in the armpits (axillary)<\/b> the <\/span>4th ganglion (T4)<\/b>. Often both areas are affected, in which case both corresponding areas are interrupted. The cut can be made using <\/span>electrical coagulation<\/b> (sclerotherapy), <\/span>cutting (resection)<\/b> or by <\/span>clipping<\/b> (application of a titanium clip to block the nerve). <\/span> <\/p>\n

    Theoretically, the latter has the advantage of being able to be reversed if necessary – in practice, however, the differences between clipping and cutting are small, as even a removed or severed nerve can grow back together in rare cases.<\/span><\/p>\n

    Procedure of the operation:<\/b> In the past, sympathectomy required a large opening of the chest (<\/span>thoracotomy<\/b>) with spreading of the ribs – an invasive procedure with a long hospital stay. <\/span> <\/p>\n

    Today it is performed using <\/span>minimally invasive technique<\/b> usually performed as <\/span>video-assisted thoracoscopic surgery (VATS)<\/b>. This means that <\/span>Smallest cuts (approx. 5 mm)<\/b>to insert a camera and fine instruments. Traditionally, each page <\/span>two small cuts<\/b> one for the camera tube and one for a working instrument. The procedure is usually performed <\/span>on both sides in one session<\/b>to eliminate sweating on both the right and left side. <\/span> <\/p>\n

    First of all, one lung is <\/span>partially collapsed for a short time<\/span><\/i> (by inducing CO\u2082 or adjusting ventilation) so that the surgeon has a view of the narrow chest cavity. The corresponding sympathetic nerve branches are identified and severed or obliterated under video guidance. <\/span><\/p>\n

    The procedure itself often only takes about <\/span>20-30 minutes<\/b>; a total of about <\/span>1 hour<\/b> Operation time for both sides. The lungs are then unfolded again. In many cases <\/span>on chest drains<\/b> This is because there is only minimal air ingress, which quickly resorbs itself. To be on the safe side, the patient is examined approx. 2 hours postoperatively. <\/span>X-ray control<\/b>to rule out a significant pneumothorax (accumulation of air). If everything is normal, the hospital stay is short.<\/span><\/p>\n

    Prospects of success:<\/b> Immediately after sympathectomy, the target regions are dry in almost <\/span>dry in almost 100 % of cases<\/b>. <\/span> <\/p>\n

    Patients wake up from anesthesia and immediately feel: their hands are warm and dry – an immediate effect. <\/span>immediate effect<\/b>which is often experienced as life-changing. In studies, the <\/span>Success rate<\/b> for the improvement of <\/span>palmar<\/b>palmar hyperhidrosis at <\/span>96-100 %<\/b> or a <\/span>cure rate of around 90-95 %<\/b>. With <\/span>axillary<\/b> hyperhidrosis, the success rate is somewhat lower (about <\/span>75-85 %<\/b>), as sweating in the armpits can be more complex and additional glandular areas (T4\/T5) sometimes play a role.<\/span><\/p>\n

    Overall, over <\/span>95 % of patients report initial satisfaction<\/b> after a sympathectomy – the quality of life increases significantly in almost all cases.<\/span><\/p>\n

    Despite this high success rate, the <\/span>downside<\/b> must be considered: possible <\/span>side effects<\/b> and <\/span>complications<\/b>. The sympathectomy permanently interrupts part of the nervous system – this is not always without consequences. For this reason, careful consideration is given and the procedure is only entrusted to experienced thoracic surgeons. <\/span><\/p>\n

    In the next section, we look at the modern development of the surgical technique (uniportal, non-intubated VATS) before discussing the risks.<\/span><\/p>\n

    Uniportals VATS – the one-port technology<\/b><\/h2>\n

    In leading centers – including ours in Berlin – thoracoscopic sympathectomy is now often performed as <\/span>uniportal VATS<\/b> is often performed. <\/span>Uniportal<\/b> means that <\/span>only one single mini-access per side<\/b> of approx. 5-10 mm in length is required instead of two or three separate incisions. Camera and instruments are inserted through the same opening, so to speak.<\/span><\/p>\n

    This <\/span>high-tech surgical technique<\/b> reduces access routes to a minimum and offers several advantages:<\/span><\/p>\n

      \n
    • Less pain and better healing:<\/b> Fewer incisions mean less trauma to muscles, nerves and tissue. In a comparative study, patients after <\/span>uniportal sympathectomy<\/b> under <\/span>significantly less pain<\/b> than with the traditional two-port technique. <\/span>
      \n<\/span>The mean pain scores in hospital were around 0.8 (uniportal) vs. 1.2 (biportal) on a scale, and fewer patients required pain medication in the weeks afterwards. Smaller wounds also heal more quickly and leave behind <\/span>Barely visible scars<\/b> (cosmetic advantage).<\/span> <\/li>\n
    • Shorter duration of surgery:<\/b> Experienced operators can work more quickly with single-port access. In the study cited, the average operation time (on both sides) in the <\/span>uniportal approach ~39 minutes<\/b>compared to ~50 minutes with the biportal approach. <\/span>
      \n<\/span>This means that the procedure can be completed around 10 minutes faster, which shortens the duration of anesthesia.<\/span> <\/li>\n
    • Equivalent safety and effectiveness:<\/b> It is important that the <\/span>success rate<\/b> of the sympathectomy is not impaired by the uniportal approach. In both techniques <\/span>100% of patients’ hands dry immediately<\/b>. Also with regard to <\/span>Patient satisfaction and side effects (e.g. compensatory sweating)<\/b> there were <\/span>no differences<\/span><\/i>. <\/span>
      \n<\/span>There were no serious complications (such as Horner’s syndrome) in either the one-port or two-port group.<\/span> <\/li>\n
    • Outpatient application:<\/b> Less postoperative pain and minimal access requirements support the goal of performing the procedure on an outpatient basis. <\/span>outpatient<\/b> procedure on an outpatient basis. <\/span>
      \n<\/span>If the procedure is uncomplicated, the patient can return home a few hours after the operation – this concept is particularly supported by the combination with the non-intubated technique (see below).<\/span> <\/li>\n<\/ul>\n

      In summary, the <\/span>uniportal VATS sympathectomy<\/b> established as “state-of-the-art”. It is just as effective and safe as conventional endoscopic methods, but with the <\/span>certain extra<\/b> in <\/span>protection<\/span><\/i> for the patient. <\/span> <\/p>\n

      For this reason, Dr. Mahoozi in Berlin prefers to use the one-port technique to enable our patients to recover as quickly as possible.<\/span><\/p>\n

      Sympathectomy without intubation (non-intubated VATS)<\/b><\/h2>\n

      Another milestone in further development is the performance of sympathectomies <\/span>without intubation anesthesia<\/b>i.e. in <\/span>spontaneous breathing<\/b>. This procedure is called <\/span>“Non-Intubated VATS (NiVATS)”<\/b> designated. <\/span>
      \n<\/span>This means that the patient <\/span>not be artificially ventilated<\/b> and is not given <\/span>general anesthesia<\/b> with a breathing tube; instead, the procedure is performed under <\/span>under local anesthesia (local anesthetic nerve blocks)<\/b> and a light <\/span>sedation (twilight sleep)<\/b>. <\/span>
      \n<\/span>The patient continues to breathe independently. Special anesthesia techniques – such as a <\/span>interthoracic vagus block<\/b>which suppresses the cough stimulus – make it possible to operate calmly in the open chest cavity despite the patient being awake.<\/span><\/p>\n

      Why this seemingly complex procedure? Because it offers amazing advantages:<\/b><\/h3>\n
        \n
      • Avoidance of general anesthesia risks:<\/b> Intubation anesthesia puts a strain on the body and can lead to sore throat, nausea, vomiting and, rarely, even lung-specific complications (atelectasis, pneumonia). <\/span>
        \n<\/span>Studies show that patients undergoing non-intubated procedures experience <\/span>fewer postoperative complaints<\/b> such as nausea, vomiting and sore throat and the risk of ventilation-related lung damage is also reduced. <\/span>
        \n<\/span>The elimination of deep anesthesia means that the <\/span>less strain on the circulatory system<\/b>This is particularly well tolerated by young, healthy patients – as hyperhidrosis sufferers usually are.<\/span> <\/li>\n
      • Faster recovery:<\/b> Without the “after-effects” of general anesthesia, patients are fit again more quickly. In one study, NiVATS was compared with classic VATS – the results showed a <\/span>shorter recovery and anesthesia time<\/b> and often <\/span>shortened hospital stays<\/b>. In procedures such as sympathectomy, which cause little tissue trauma, the benefits can be particularly exploited: It has been found that NiVATS sympathectomy <\/span>can often be discharged on the same day<\/b>because patients recover more quickly. <\/span>
        \n<\/span>In a Swiss study <\/span>90 %<\/b> of the non-intubated sympathectomy patients were <\/span>outpatient<\/b> treated, compared to only 30% under conventional anesthesia. This saves time and costs.<\/span> <\/li>\n
      • Cost savings:<\/b> Less medication, shorter surgery and hospitalization times lead to <\/span>lower overall costs<\/b> per procedure. This is particularly relevant in the healthcare system, but is also an advantage for patients (e.g. shorter absence from work).<\/span> <\/li>\n
      • High acceptance of the OP:<\/b> Hyperhidrosis is not a life-threatening condition – many patients are reluctant to undergo surgery, partly because of the general anesthetic. The possibility of intervening in <\/span>Gentle anesthesia<\/span><\/i> (without intubation) lowers the inhibition threshold. Internationally, it is reported that NiVATS contributes to the fact that an OP is considered a <\/span>“easier” to perceive<\/b> and more sufferers dare to take the step towards a definitive cure. <\/span>
        \n<\/span>Surgeons even often use sympathectomy as an entry point to establish a NiVATS program in the hospital because the patients are young and healthy and the procedure is so well suited to it.<\/span><\/li>\n<\/ul>\n

        Is the procedure safe?<\/b> – Yes, in experienced hands, the NiVATS sympathectomy is <\/span>is just as safe<\/b> as under general anesthesia. The challenge lies in the coordination of the team: anesthesia and surgery work hand in hand to keep an awake patient stable. But numerous studies and reports show that <\/span>Complications do not increase<\/b>.<\/span><\/p>\n

         <\/p>\n

        For example, no increased pneumothoraces or hemodynamic problems occurred in this setting either; if a cough or restlessness does occur, intubation can be switched to at any time. <\/span><\/p>\n

        In an Italian clinic in 2005, more than 30 patients were treated <\/span>underwent bilateral sympathectomies<\/span><\/i> sympathectomized – <\/span>without serious incidents<\/b>. <\/span> <\/p>\n

        About 20% showed small (<30%) pneumothoraces that did not require treatment, and the long-term results (including quality of life) were equivalent to the general anesthesia group – with even <\/span>better patient satisfaction<\/b> and <\/span>less effort<\/b>. This and more recent data confirm: the <\/span>Non-intubated thoracoscopic sympathectomy is feasible, safe and efficient<\/b>.<\/span><\/p>\n

        Outpatient sympathectomy:<\/b> Through the combination of minimally invasive <\/span>uniportal-VATS<\/b> and <\/span>non-intubated anesthesia<\/b> the procedure can nowadays in many cases be <\/span>outpatient<\/b> take place. The patient comes to the clinic in the morning on an empty stomach, is operated on under sedation and can go home again in the afternoon or evening after a monitoring phase and X-ray control. <\/span><\/p>\n

        At our Thorax Center Berlin, this is the usual procedure for suitable patients. Of course, each patient is assessed individually; if pre-existing conditions or fears speak against an awake anesthesia, a safe general anesthesia can still be used. Nevertheless, experience shows that many of those affected appreciate the opportunity, <\/span>without “general anesthesia” and overnight stay<\/b> to be treated. The inhibition threshold is lowered and the path to dry hands is shorter.<\/span><\/p>\n

        Prospects of success and risks of sympathectomy<\/b><\/h2>\n

        The <\/span>thoracic sympathectomy<\/b> is considered a <\/span>highly effective procedure<\/b> for focal hyperhidrosis – but with possible side effects. It is therefore important to provide patients with comprehensive information in advance.<\/span><\/p>\n

        Effectiveness:<\/b> As mentioned, the <\/span>immediate prospects of success are excellent<\/b>. For <\/span>palmar sweating<\/b> the success rate is ~95 % and for underarm perspiration ~75-80 % complete anhidrosis. <\/span> <\/p>\n

        Recurrences<\/b> (relapses) are rare – in experienced centers, renewed sweating in the treated areas is reported in only a few percent of cases. If a recurrence does occur, this can be prevented by <\/span>nerve regeneration<\/b> or incomplete transection; a repeat thoracoscopy for repair is then possible, but is rarely required. <\/span> <\/p>\n

        Overall, long-term studies show that the <\/span>satisfaction rate remains permanently high<\/b> even though some patients live with side effects.<\/span><\/p>\n

        Main side effect: compensatory sweating.<\/b> This refers to increased sweating in other parts of the body to <\/span>compensation<\/b>. <\/span> <\/p>\n

        If, for example, the palms of the hands no longer sweat, the body can release more excess heat through the back, chest, stomach or legs. <\/span><\/p>\n

        How often does this occur?<\/b> The figures vary: In the literature, rates of only <\/span>~3 % to almost 100 %<\/b> – This enormous range is due to different definitions and survey periods. It is realistic that in <\/span>about half of the cases<\/b> some degree of compensatory sweating occurs. <\/span> <\/p>\n

        It usually manifests itself as slightly increased sweating of the torso or legs during heat or exercise. Many patients perceive this as <\/span>little disturbing<\/b> compared to the previously soaking wet hands. <\/span> <\/p>\n

        However, around <\/span>5-10 %<\/b> of those operated on report <\/span>increased compensatory sweating<\/b>which is perceived as unpleasant in everyday life. In a few cases, it can be so pronounced that it impairs satisfaction. <\/span><\/p>\n

        Important to know: Very heavy compensatory sweating (so that the patient regrets the operation) is rare – patients are usually happy despite a little more sweating on the body <\/span>happy about dry hands<\/b>. <\/span> <\/p>\n

        In addition, there is often a <\/span>attenuation<\/b> of this side effect after a few months to years. Nevertheless <\/span>before the operation<\/b> be discussed in detail. There are <\/span>Not a reliable method<\/b>predict who will develop compensatory sweating. The <\/span>Surgical technique<\/b> (clip vs. incision, height T2 vs. T3 etc.), no clear scientific influence could be determined – for example, whether a particularly high or low incision is made does not clearly change the risk.<\/span><\/p>\n

        Some surgeons prefer not to operate too close to the stellate ganglion (T1) in order to avoid certain side effects; the standard procedure is to operate at the T3\/T4 level anyway. It is important that the patient is aware of this possible consequence and weighs it up against the expected benefit (dry main problem area).<\/span><\/p>\n

        Other possible side effects and complications:<\/b><\/p>\n

          \n
        • Horner’s syndrome:<\/b> If during the operation the <\/span>the uppermost thoracic ganglion (stellate ganglion, approximately at T1 level)<\/b> would be damaged during surgery, a so-called Horner’s syndrome could occur. <\/span>
          \n<\/span>This leads to a slightly drooping upper eyelid, a constricted pupil and a slight drooping of the eyeball on the affected side. The probability of this is very low (approx. <\/span>1 % of cases<\/b> or less), as this ganglion, when correctly performed sympathectomy <\/span>above<\/span><\/i> of the target area and is not cut through. If it does occur, the symptoms often disappear partially or completely within weeks.<\/span> <\/li>\n
        • Neuropathic pain\/intercostal neuralgia:<\/b> Every thoracoscopy requires access between the ribs, which can irritate the nerves there. In most cases <\/span>Postoperative pain low<\/b> and subside in days. Very rarely, a persistent <\/span>intercostal neuralgia<\/b> (nerve pain) can occur. <\/span>
          \n<\/span>In studies, chronic nerve pain is only mentioned in a few percent (<2-3%). These can usually be treated well with painkillers and subside over time.<\/span> <\/li>\n
        • Pneumothorax:<\/b> As with any procedure in the chest cavity, there is the possibility of a small air leak into the pleural cavity. In fact, X-rays after sympathectomy sometimes show a minimal pneumothorax, especially if the lung did not fully unfold or tiny leaks developed in the lung surface.<\/span>
          \n<\/span>In <\/span>over 95 %<\/b> of cases this is so low that <\/span>no drainage<\/b> is required. Should a larger pneumothorax occur after all (very rare), a <\/span>Pleural drainage<\/b> is placed and the hospital stay is extended by 1-2 days.<\/span> <\/li>\n
        • Bleeding:<\/b> Significant bleeding is rare, as only small vessels run through the area. The procedure is <\/span>very safe<\/b>serious bleeding or injuries to the lungs\/heart hardly ever occur in experienced hands. The general complication rate in larger series with <\/span>by 1-3%<\/b> (including all minor incidents).<\/span> <\/li>\n<\/ul>\n

          Overall, experience has shown that thoracoscopic sympathectomy – when performed correctly – is a very safe operation. <\/span>very safe operation<\/b> with <\/span>low complication rate<\/b>. <\/span>The most common “side effect” remains compensatory sweating<\/span><\/i>that you have to be aware of. The <\/span>Most patients<\/b> do not regret the procedure, but would recommend it <\/span>recommend it to others<\/b>because the benefits (e.g. dry hands, new self-confidence) clearly outweigh the possible side effects. <\/span>
          \n<\/span>It is important to obtain detailed advice from experienced specialists in order to set the right expectations.<\/span><\/p>\n

          Frequently asked questions (FAQ)<\/b><\/h2>\n

          What exactly does “hyperhidrosis” mean?<\/b>
          \n<\/b>Hyperhidrosis means <\/span>excessive sweating<\/b>. The body produces more sweat than is necessary to regulate temperature. <\/span><\/p>\n

          This typically occurs in certain areas (hands, armpits, feet, face) and begins in adolescence. It is a recognized medical condition that can be very stressful for those affected.<\/span><\/p>\n

          What are the causes of excessive sweating?<\/b>
          \n<\/b>It is often a case of <\/span>primary hyperhidrosis<\/b>where there is no underlying disease. The vegetative nervous system is probably overactive in this case – often <\/span>Genetics<\/b> and <\/span>stress<\/b> also play a role. <\/span> <\/p>\n

          However, sometimes there is something else behind it (secondary hyperhidrosis), e.g. <\/span>hormonal disorders<\/b> (thyroid gland), <\/span>diabetes<\/b>, <\/span>infections<\/b> or <\/span>medication<\/b>. The doctor will clarify this by taking a medical history and, if necessary, carrying out examinations.<\/span><\/p>\n

          What non-surgical treatments are available?<\/b>
          \n<\/b>First of all you try <\/span>simple measures<\/b>: Special <\/span>antiperspirant deodorants<\/b> with aluminum chloride can reduce underarm perspiration. On hands and feet often helps <\/span>Iontophoresis<\/b> (weak current in a water bath). <\/span> <\/p>\n

          Botox injections<\/b> can locally shut down the sweat glands (effective for approx. 6 months). There are also tablets (anticholinergics), but these have side effects. Home remedies and relaxation techniques are also tried out. These methods can reduce sweating, but some of them have to be used repeatedly. They often reach their limits with very heavy sweating.<\/span><\/p>\n

          When should a sympathectomy be considered?<\/b>
          \n<\/b>When <\/span>all conservative therapies have been exhausted<\/b> are exhausted and still <\/span>high level of suffering<\/b> exists. For example: you have tried various deodorants, medication, Botox etc. for years without sufficient success, and sweating continues to have a massive impact on your professional and private life. A sympathectomy can then be performed as a <\/span>last step<\/b> be useful. <\/span> <\/p>\n

          Of course, the possible side effects (e.g. compensatory sweating) must be weighed against the expected benefits. A consultation with an experienced thoracic surgeon is important here. For certain professional groups (e.g. surgeons with palmar hyperhidrosis) an earlier surgery may be indicated, as dry hands are essential.<\/span><\/p>\n

          How does the sympathectomy actually work?<\/b>
          \n<\/b>This is a <\/span>minimally invasive procedure<\/b> on the chest. Under general anesthesia (or in certain cases under sedation, see below), a tiny camera is inserted between the ribs, as well as a fine instrument. <\/span><\/p>\n

          The surgeon cuts the sympathetic nerve that controls sweating, e.g. in the hand, under visual control. This is done on both sides. The operation only takes about 1 hour in total. Then you wake up and immediately notice that your hands\/armpits are dry. In most cases, no drainage remains in the chest. After a short period of monitoring, you can either go home the same day or stay overnight for safety reasons, depending on the clinic.<\/span><\/p>\n

          Is it true that the operation can be performed without general anesthesia?<\/b>
          \n<\/b>Yes, in specialized centers, sympathectomy is also performed without intubation. <\/span>without intubation<\/b> carried out. You then get a <\/span>Twilight sleep<\/b> and local anesthesia. You are not fully conscious during the operation, but you are not under deep anesthesia either – comparable to a gastroscopy under sedation. <\/span><\/p>\n

          This method (non-intubated VATS) eliminates the need for a breathing tube and many anesthetic side effects. Not every patient is suitable for this (e.g. severe anxiety patients or certain lung diseases), but it works very well for young, healthy people. Your thoracic surgeon and anesthesiologist can assess whether this option is suitable for you.<\/span><\/p>\n

          How long do I have to stay in hospital?<\/b>
          \n<\/b>As a rule, the stay is <\/span>very short<\/b>. Many clinics perform the procedure <\/span>outpatient<\/b> This means that you can return home on the day of the operation. Otherwise you are usually left with <\/span>One night of observation<\/b> and is discharged the next day. It is important that X-rays and examinations are carried out beforehand to ensure that there is no significant pneumothorax. If everything is ok and you feel well, there is nothing to stop you being discharged.<\/span><\/p>\n

          How quickly will I be fit again?<\/b>
          \n<\/b>Surprisingly fast: as only small incisions are made, most patients experience hardly any pain. <\/span>hardly any pain<\/b> – possibly a slight feeling of pressure in the chest for a few days. This is easily manageable with painkillers. After a few days you can usually <\/span>normal everyday activities again<\/b> record. Heavy physical exertion or sport should be avoided for about 1-2 weeks so that everything can heal internally. Office work is often possible again after just a few days. Your doctor will give you precise instructions. Overall, the recovery time is very short compared to major operations.<\/span><\/p>\n

          What is compensatory sweating? Do I get that?<\/b>
          \n<\/b>This is the <\/span>compensatory sweating<\/b> in other parts of the body after the operation. It is the most common side effect of sympathectomy. For example, you notice that your back or legs sweat a little more than before, especially in the heat. <\/span><\/p>\n

          Whether and to what extent<\/b> that occurs varies from person to person. Statistically, about half of patients experience some form of compensatory sweating, but often so mild that it is hardly bothersome. Only a small minority (5-10%) have it to such an extent that it is perceived as problematic. <\/span><\/p>\n

          Unfortunately, it is impossible to predict who will be affected. It has nothing to do with the skill of the surgeon or your body type. Important: You should be aware of the possibility. In most cases, however, the relief of dry hands\/shoulders clearly outweighs this. Compensatory sweating can also improve again over time. If it would be extremely annoying, there are options in individual cases such as medication or (rarely) the removal of clips – but these are exceptional cases. Discuss your concerns with the doctor; he or she will honestly assess whether the operation makes sense for you.<\/span><\/p>\n

          What other risks does the operation entail?<\/b>
          \n<\/b>Serious complications are <\/span>very rare<\/b>. As with any operation, there is a risk of anesthesia (with general anesthesia) and a minimal risk of infection or bleeding, but this is in the low percentage range. A small air leak in the lungs could cause a <\/span>Pneumothorax<\/b> If it is larger, a drain would be placed, which would extend the stay by 1-2 days. But this hardly ever happens, as the camera access points are tiny. <\/span><\/p>\n

          Injuries to important organs (heart, large vessels) are practically not to be expected in the position of the sympathetic chain as long as an experienced thoracic surgeon operates. The <\/span>Horner syndrome<\/b> (see above) is very rare (~1 %). In short: the procedure is very safe and the risks are low. Nevertheless, everything is of course done to further minimize even these small risks – for example through state-of-the-art imaging technology, monitoring and the experience of the surgical team.<\/span><\/p>\n

          Will the result last forever? Can the sweating come back?<\/b>
          \n<\/b>As a rule, the result is <\/span>permanent<\/b>. The severed nerve endings do not normally regenerate to the extent that the sweating function returns. In studies, the relapse rate is around 5-10%, depending on the observation period – this means that a small number of patients notice increased sweating in the areas originally treated again after months or years. <\/span><\/p>\n

          However, this is often far less pronounced than before the operation. If a relevant relapse does occur, a new thoracoscopy can be performed to check whether there are, for example <\/span>second nerve tracts<\/b> who step in, or whether the first intervention was incomplete. This can then be corrected retrospectively. However, the vast majority of patients (over 90%) remain in the affected zones permanently <\/span>anhidrotic<\/b> (dry) and happy with the result of the operation.<\/span><\/p>\n

          Does the health insurance company cover the costs?<\/b>
          \n<\/b>As sympathectomy for hyperhidrosis is an established therapeutic procedure, the costs are generally covered by statutory and private health insurance companies <\/span>covered<\/b> – <\/span>provided that<\/b>it is a case of <\/span>pathological<\/span><\/i> hyperhidrosis and conservative treatments have been tried without success. <\/span> <\/p>\n

          Your doctor will document which therapies have already taken place before you apply for cost coverage. <\/span><\/p>\n

          In Germany, endoscopic thoracic sympathectomy for primary hyperhidrosis is listed in guidelines as a therapy pillar, so there are usually no problems with cost coverage. If in doubt, check with your health insurance company in advance whether cost approval is required. In many cases, the clinics carrying out the procedure also take care of the approval.<\/span><\/p>\n

          Your specialists for hyperhidrosis in Berlin and the surrounding area<\/b><\/h2>\n

          If you suffer from severe sweating and are looking for a definitive solution, we are at your disposal at the <\/span>Knowledge Center Thoracic Surgery Berlin<\/b> under the direction of <\/span>Dr. Hamidreza Mahoozi<\/b> will be happy to help you. <\/span> <\/p>\n

          As experienced thoracic surgeons, we offer the <\/span>modern uniportal VATS sympathectomy<\/b> – for suitable patients also <\/span>non-intubated and outpatient<\/b> – to. In our consultation hours we advise those affected from <\/span>Berlin, Brandenburg<\/b> as well as nationwide e.g. from <\/span>Leipzig, Dresden or Hanover<\/b> about the possibilities of hyperhidrosis treatment. Make an appointment to discuss your questions in person. We help you to escape the vicious circle of sweat and avoidance – for a <\/span>a dry, self-confident life<\/b> without hyperhidrosis.<\/span><\/p>\n

          Sources<\/b><\/h3>\n
            \n
          1. Cesur E.E. et al. (2018). <\/span>Non-Intubated Bilateral Single Port Endoscopic Thoracic Sympathectomy<\/span><\/i>. South. Clin. Is. Euras. <\/span>29<\/b>(1):49-52<\/span><\/li>\n
          2. German Dermatological Journal (2005). <\/span>Hyperhidrosis – causes and current treatment options<\/span><\/i>. Thieme, 2005<\/span><\/li>\n
          3. International Hyperhidrosis Society – News Blog (2021). <\/span>New Research Documents Quality-of-Life Burden of Hyperhidrosis<\/span><\/i><\/li>\n
          4. Caviezel C. et al. (2019). <\/span>Establishing a non-intubated thoracoscopic surgery program for bilateral uniportal sympathectomy<\/span><\/i>. Swiss Med Wkly <\/span>149<\/b>:w20064<\/span><\/li>\n
          5. Haessig G., Caviezel C. (2021). <\/span>NiVATS sympathectomy for hyperhidrosis: should I stay or should I go? A Narrative Review<\/span><\/i>. Video-assist Thorac Surg <\/span>6<\/b>:29<\/span><\/li>\n
          6. Chen Y.B. et al. (2009). <\/span>Uniportal versus biportal video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis<\/span><\/i>. Chin Med J <\/span>122<\/b>(13):1525-1528<\/span><\/li>\n
          7. Elia S. et al. (2005). <\/span>Awake one-stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis: a safe outpatient procedure<\/span><\/i>. Eur J Cardiothorac Surg <\/span>28<\/b>(2):312-317<\/span><\/li>\n
          8. University Medical Center Freiburg – Thoracic Surgery (2023). <\/span>Patient information hyperhidrosis<\/span><\/i><\/li>\n
          9. Klinikverbund Bielefeld – EvKB Thoracic Surgery (2021). <\/span>Non-intubated VATS in Bethel – information flyer<\/span><\/i><\/li>\n
          10. CHOP – Children’s Hospital of Philadelphia (2020). <\/span>Hyperhidrosis Surgery (Thoracoscopic Sympathectomy) – Patient Story<\/span><\/i><\/li>\n<\/ol>\n

             <\/p>\n","protected":false},"excerpt":{"rendered":"

            Hyperhidrosis refers to excessive sweating that goes far beyond what is necessary to regulate body temperature. Those affected often suffer from constantly damp hands, soaked clothing or visible sweat stains, which leads to great psychosocial stress. It is estimated that 1-3% of the population are affected by primary hyperhidrosis – men and women alike. Symptoms typically begin in adolescence or young adulthood and can occur without an identifiable cause. <\/p>\n","protected":false},"author":1,"featured_media":20619,"parent":20381,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-20535","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/pages\/20535","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/comments?post=20535"}],"version-history":[{"count":5,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/pages\/20535\/revisions"}],"predecessor-version":[{"id":45559,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/pages\/20535\/revisions\/45559"}],"up":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/pages\/20381"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/media\/20619"}],"wp:attachment":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/media?parent=20535"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}