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Thoracoscopic Sympathectomy (TES)


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 an anaesthetic.

 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%.

            Slow expansion of the lung after the operation is unusual, but is treated by placing a drain in place if necessary.  Risk is under 5%.

             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 persistent.


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 reschedule.

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.