Excessively sweaty palms are usually no more than a nuisance. Occasionally, however, they may cause social embarrassment or interference with sports or occupation. Medical treatment with dermatological agents and iontophoresis sometimes work and this should be attempted. Those who fail conservative treatment and are incapacitated with the problem may consider surgery for a permanent cure.

A procedure called Thoracoscopic Sympathectomy can be done. The main principle of the operation is to divide the sympathetic nerves which control sweating in the palms. The nerves are found in the thoracic cavity running along the neck of the ribs. A complete division of the nerves from the second to the fourth rib is usually recommended. Those patients with excessive sweating in the armpits may require a modification of the levels divided.

The entire operation can be performed with the keyhole technique called Thoracoscopy. A 5 mm telescope is used to visualization. Two 3 mm instruments are used to locate, dissect and divide the sympathetic nerves.

Some surgeons do this procedure on one side first and delay the procedure on the other side till a few weeks later. We prefer to do both sides at the same time if the patient is young and fit. This obviates the need for two separate operations.

The operation is done under General Anaesthesia. Patients are usually admitted to hospital on the day of surgery and stay overnight for observation. A small chest tube is sometimes left inside the rib cage for a few hours after the surgery is completed. This can be removed once the lung is fully re-expanded.

Recovery is usually rapid as only small keyhole incisions are used. Occasionally, however, you may feel some pain for the first few weeks. This can sometimes be intermittently severe. There may also be a feeling of heaviness in the chest and pain in the arms for a few days. Temporary recurrence of the sweaty palms, lasting for a few hours, may happen especially between the second and fifth day after surgery.

Most patients are completely satisfied with the results of surgery. They can, however, have compensatory excessive sweating in the trunk due to a rebound phenomenon. This is usually of little concern but do remember that it can happen and it cannot be prevented. Surgery is also irreversible once it is done so do reconsider whether you want to have the operation if you feel that this side effect is going to bother you.