When all other treatment options have been exhausted, the hyperhidrosis patient may turn to surgery. Sympathectomy involves cauterizing (cutting and sealing or clipping) a portion of the sympathetic nerve chain that runs down the backbone, parallel to the spinal cord. This operation permanently interrupts the nerve signal that is causing the body to sweat excessively or the face to blush excessively.

Thanks to advanced technology providing visual assistance to guide the surgeon, this can be accomplished without open surgery. In an endoscopic thoracic sympathectomy, the surgeon inserts a miniature camera and instruments into the chest through small slits similar to that used for knee arthroscopy. The surgeon cuts or clips the sympathetic nerves of the ganglion using magnification and illumination provided by the camera.

The procedure is performed bilateraly in the same session. It lasts approximately an hour, is performed on an out-patient basis and most patients return to work and regular physical activity within one week. The endoscopic technique is considered safe and is curative in 98% of patients.

As with any surgical procedure, there is some level of risk for the procedure. There are few risks involved with thoracoscopic surgery. Some are related to general anesthesia, chest surgery, and some are related specifically to TS SYM. These include bleeding, infection and pneumothorax or lung collapse. Those risks specific to sympathectomy include Compensatory Sweating and Horner's Syndrome.

• Compensatory Sweating: sweating occurring in sites other than the original site of hyperhidrosis. This may occur in up to 40 percent of patients and occurs immediately or months after the surgery. Sometimes the compensatory sweating will resolve.
• Horner's Syndrome: caused by damage to the stellate ganglia, which is avoided as much as reasonably possible by the surgeon. This can result in decreased facial sweating, eyelid drooping, and enlarged pupil on the opposite side. Horner's Syndrome is more likely to occur when working higher up on the sympathectic nerve chain, especially when treating facial blushing. A minor plastic surgery procedure can correct the eyelid drooping and the other symptoms are not externally obvious to the untrained person.