These patients do not usually consider surgery first. Most of them have used a variety of other methods including local anti-sweating medicine and an electrophoretic device to deal with their condition. Transthoracic sympathectomy is also useful for other conditions besides hyperhidrosis of the hands and feet. Previous lung surgery and emphysema are relative contraindications to this procedure but should considered on a case by case basis. Careful and detailed discussions are always undertaken prior to surgery between the surgeon and the patient.
General anesthesia is administered via a double lumen endotracheal tube.
This allows the anesthesiologist to deflate one lung at a time to allow the surgeon to approach the sympathetic chain through the chest. Afterwards a chest tube is left in place for a few hours to evacuate any remaining air. Following this the patient is removed from the ventilator, permitted to awaken fully and a chest x-ray is obtained. Once the x-ray is cleared the chest tubes are removed then the patient can be sent home. The patient has two incisions which are hidden by each armpit.