Sweating is one of the most important ways in which the body loses heat; however, people with excessive sweating produce sweat in amounts far greater than needed to control their temperature. Hyperhidrosis is the medical term for excessive sweating. About 0.5% of the population – or 1 person in 200 – has some form of hyperhidrosis. It usually starts between their teens and twenties, because of overactive sweat glands. Sweat glands are fed with certain types of nerves called sympathetic nervous system, which one of its functions is to control sweating. Sympathetic nervous system can be more active which leads to essential/primary hyperhidrosis. The cause of this problem is unknown but apparently is related to genetic issues. Hyperhidrosis can also be secondary type which followed by overactivity of thyroid gland, adrenal gland or diabetes.
Excessive sweating can be treated by:
A type of electrolysis
Injection of botulinum toxin
Sympathectomy with RF
Simple or medical treatments of essential hyperhidrosis might not control the symptoms, or they might induce intolerable side effects. In these cases, sympathectomy can be useful. Sympathectomy is a surgical technique that aims to destroy part of the nerve supply to the sweat glands in the skin. This type of surgery (thoracoscopy) can be used to control sweating of the armpits and palms of the hands or soles of the feet.
Thoracic Sympathectomy (for armpits and hands) : The sympathetic nerve supply to the arms and hands comes from inside the chest, which used to make it difficult for surgeons to reach easily. Thoracic sympathectomy has become more widely used with the development of modern ‘keyhole’ (laparoscopic) instruments and cameras. The patient is given a general anaesthetic. A laparoscopic camera is introduced into the chest between two ribs just below the armpit, using a small incision (cut) less than one cm long. To allow the surgeon to see the nerves clearly, the lung on that side of the chest is briefly deflated. A second laparoscopic instrument is then introduced through another small incision, and this is used to destroy the nerve using an electrical current.
Lumbar Sympathectomy (for feet) : The sympathetic nerves that supply the sweat glands of the feet are at the back of the abdomen. This is a more involved operation than the cervical sympathectomy. It is usually done as an ‘open operation’, involving small incisions in the side of the abdomen. Most patients stay in hospital overnight after this procedure and a full recovery can take two to four weeks.
Sympathectomy with RF
Sympathectomy also can be performed with RF. This procedure has been performed in some medical centers but in Iran it is only performed by Dr. Bagherzadi. Radiofrequency sympathectomy is a non-invasive procedure which does not need general anesthesia, one-lung ventilation and incision. RF thoracic and lumbar sympathectomy are performed with the help of C-armed flouroscopy in operation room. The location of sympathetic chain is confirmed through 1% lidocaine test, x-ray radiography or prescribing medical contrast medium. In RF sympathectomy, very slim needles are entered from posterior chest (after local anesthesia) and placed beside sympathetic chain after passing intercostal space. The active tip of needles are not insolator, thus (near sympathetic chain) the emitted waves generate heat as much as 80 ˚C that can destroy the sympathetic chain in two minutes. This leads to removing armpits, palm of hands and soles of feet sweating. During the procedure, the patient is completely conscious and after it, he/she can go home and resume his/her routine activities.
Percutaneous RF lumbar sympathectomy can be used, too, in patients with vascular problems in the lower limbs (diabetes, vascular pathology…) as well as in cases of neuropathic pain. Radiofrequency (RF) therapy uses electromagnetic energy, which is deposited in or near nerve tissue.
The results show that thoracic sympathectomy is the most effective method for treating hyperhidrosis. In addition, RF sympathectomy in comparison with thoracoscopy is recommended, since it is minimal invasive and does not need general anesthesia. Also it has less side effects and shorter recovery time. Patients’ reflex after RF sympathectomy is also less than sympathectomy surgery.