Thoracoscopic Sympathectomy (TES)
TRANSTHORACIC ENDOSCOPIC SYMPATHECTOMY
This procedure is usually carried out for excessive sweating in
the hand or arm, or for facial flushing. It is relatively
unusual and only performed in some hospitals. The success and
risk rates published are the overall experience of hospitals where
it is available. The other principal alternatives are
frequent use of conventional antiperspirants, and injection of
Botulinus toxin to the affected area. Patients have
inevitably tried the first, and at MRI we use Botox for recurrent
symptoms, those limited to the armpit, or patients unable to have
The operation involves a general anaesthetic, and one or
two (occasionally three) small incisions on the side of the chest
under the arm. During the operation, these will allow access
to the nerves in the chest that supply the sweat glands in the hand
and arm, so these can be divided using keyhole surgery with a
camera. The operation takes approximately one hour.
Post operatively, the stay in hospital will be around 1-2
days, with discharge after a chest x-ray.
The main risks are those of any general anaesthetic, which
will depend on your general health. In addition, the nature
of this particular operation means there are specific complications
which may rarely occur.
Bleeding during the operation is rare, but may be serious and
require a bigger incision in the chest if it cannot be
controlled otherwise. Risk is less than 1%.
expansion of the lung after the operation is unusual, but is
treated by placing a drain in place if necessary. Risk is
Although the operation involves dividing the nerves to the sweat
glands, these run very near the nerves supplying feeling to
the arm and are identical in appearance.
There is therefore a small chance of damage to these nerves during
the operation, which may produce either numbness, tingling or
aching in part of the arm after the operation. Risk is around
1%. Although this usually recovers, a small number are
There have been reports of stretching injury to the nerves at
the base of the neck which supply the arm, probably due to the
position of the arm during surgery. Although exceptionally rare,
this can leave the arm weak or painful and may take months to
recover. Risk is under 1 in 1,000.
The nerves supplying the sweat glands on the face, and some
eyelid movements are part of this group of nerves. Some
patients will develop a slight droop of the eyelid, and a small
pupil post operatively. Risk is under 5%. Although this
usually recovers, a small number are persistent.
We aim to do both sides at the same time, but if there is any
doubt about safety we will stop operating after the first side and
The operation is immediately successful at controlling the
sweating in around 95% of patients, but in some patients it recurs
months or years later probably due to regrowth of the nerves.
This is unpredictable.
It is also possible for the sweating to develop at sites
previously unaffected, such as back or chest. This is called
compensatory hyperhidrosis. The face can also become prone to
flushing which can be noticeable. There is no effective
further surgery for this.
Where the operation is performed on both sides, the results may
differ slightly. This is something that should be
particularly considered when the procedure is for facial flushing
as the asymmetry may be more noticeable than the blushing.
Overall, most people are significantly improved by the
operation. A small number are not made better or are worse,
and a few will end up with new problems.