Hyperhidrosis is a condition in which excessive secretion of sweat glands is caused by over-excitation of the sympathetic nerves. The sympathetic nerve governs sweating throughout the body. Normally, the sympathetic nerves regulate the body’s temperature by controlling sweating and heat loss. In hyperhidrosis, however, the normal control of sweating and flushing is completely lost. Excessive sweating and facial flushing can lead to helplessness, agitation or panic on a daily basis. Causes of Hyperhidrosis Hyperhidrosis is caused by an overproduction of small sweat glands and is characterized by abnormally excessive sweating either generalized (generalized hyperhidrosis) or localized (restrictive hyperhidrosis). Hyperhidrosis can be secondary to certain psychoneurological diseases, metabolic diseases, endocrine disorders, tumors, drugs, etc., known as secondary hyperhidrosis; primary hyperhidrosis etiology is not known, the most common parts are palms, armpits and soles, occasionally occur in the head and neck, trunk and lower legs. The onset of the disease starts from childhood and worsens in adolescence and lasts for life. When the disease is serious, it not only affects the patient’s work, life and study, but also causes psychological disorders and prevents the patient from participating in normal social life. There are many traditional treatments, but they are often ineffective, including astringents, antiperspirants, sedatives, hypnotherapy, psychotherapy, iontophoresis and acupuncture. Thoracic sympathetic ganglion or sympathetic trunk resection is currently the only effective and long-lasting treatment for hyperhidrosis, but in the past, the surgery was performed bilaterally with large trauma, incision scars affecting the function and aesthetics, which was often difficult for patients to accept. Currently, TV thoracoscopic thoracic sympathetic trunk amputation is less traumatic, good exposure, accurate localization, safe and reliable, fast postoperative recovery, satisfactory and long-lasting efficacy, and can be completed at the same time bilateral surgery, which is acceptable to patients. So far, our hospital has successfully performed TV thoracoscopic thoracic sympathetic trunk dissection for several patients, and the patients’ hyperhidrosis symptoms disappeared immediately after the operation, and they were discharged from the hospital in 2~3 days without complications. All patients were able to participate in normal work and study right after discharge from the hospital without recurrence of symptoms, and the efficacy of the treatment was satisfactory. In conclusion, TV thoracoscopic thoracic sympathetic trunk dissection is the safest and most effective treatment for hyperhidrosis. Generalized hyperhidrosis can be an abnormal physiological response or one of the symptoms of certain diseases such as hyperthyroidism and diabetes mellitus. Localized hyperhidrosis can be due to sympathetic nerve damage or an abnormal response with increased production of choline acetate, which causes the small sweat glands to produce excessive sweat. Hyperhidrosis can be broadly categorized into three groups in terms of its causes. One is due to systemic diseases, such as endocrine disorders (hyperthyroidism, diabetes mellitus, pituitary hyperfunction, etc.), neurological disorders, some infectious diseases (malaria, tuberculosis, etc.) and long-term illnesses resulting in physical weakness. As long as these systemic diseases are controlled after excessive sweating can be resolved. Second, mental sweating, due to high tension and emotional excitement caused by sympathetic dysregulation, internal sedative drugs (such as atropine, probenecid, belladonna, etc.) has a temporary effect, but there are side effects such as dry mouth. Third, gustatory sweating, belongs to another physiological phenomenon, such as eating certain stimulating foods (chili, garlic, ginger, cocoa, coffee) caused by excessive sweating, this situation generally do not have to be treated, only must be avoided. What is the need for surgery? A: If your excessive sweating significantly affects your socializing, schooling, work, mood and life, and significantly reduces your self-confidence, then you should have surgery. Why do I sweat excessively? A: In normal people, increased sweating is caused by sympathetic hyperfunction when there is tension, excitement, stress, or high summer temperatures. However, hyperhidrosis is often caused by overdeveloped sweat glands or parietal glands and an oversensitive sympathetic nerve that regulates sweat production. In a few cases, excessive sweating is caused by hyperthyroidism. What are the risks of hyperhidrosis? A: Hyperhidrosis can occur from a young age (around 6 years old) and is more pronounced in adolescence, with the most troubling symptoms being excessive sweating of the palms, armpits, and feet. Young people’s emotions are not easy to control, easy to nervousness, uneasiness, shyness, fear, etc., so that sweating is more powerful, the more anxious mood, the more sweating, resulting in a vicious circle. This may cause patients to be withdrawn, introverted, not good at socializing, lack of confidence in social situations, and even low self-esteem, which will also affect learning and job hunting. What is the incidence of hand sweating? A: Hand sweating can occur in both men and women, and is quite common in young people of Eastern ethnic groups, with a familial rate of up to 12%. It has been seen that both parents have hyperhidrosis, and all four children have varying degrees of hyperhidrosis. Many people with excessive hand sweating have a family history of the condition, but it is not always passed on to the next generation. What are the treatment options for hand sweating? A: So far, the only true cure is surgery. The most effective, fast and minimally invasive surgical procedure for the treatment of hand sweating is thoracoscopic thoracic sympathetic nerve amputation/clamping. When is the best time to operate? A: Because hand sweating persists, the sooner you treat it, the sooner you can get rid of the problem. The best time to treat hand sweating is during adolescence when symptoms are most noticeable. Sweaty palms can be relieved immediately after surgery, and the success rate of the surgery is close to 100%; however, if sweating is already a nuisance and an inconvenience in elementary school, there is no technical difficulty in operating on a child over the age of six. After the age of forty, the surgery becomes difficult and the failure rate increases, often due to diseases such as pleural adhesions or lung lesions. How long after surgery will my hands stop sweating? A: 10 – 20 minutes after thoracoscopic surgery to sever/clamp the thoracic sympathetic nerve, the hands will stop sweating and gradually become warm and dry. What is the incision method of treating hand sweating and do I have to be hospitalized? A: The traditional surgical method is to cut from the center of the back and remove the second and third sympathetic ganglia on both sides. This method has a longer operation time and recovery time, and there is a wound of about five to seven centimeters after the operation, which is more painful and requires hospitalization; today’s surgical method has been changed to thoracoscopic surgery, and the wounds are located in the axillae of the two sides, each of which is about 0.3-1.0 centimeters, and general anesthesia is used, which has a shorter operation time and recovery time. The operation time and recovery period are shorter, and the pain is mild. For safety reasons, the patient is usually hospitalized for 1-2 days after the operation. Do I need special care at home after the surgery? A: It is normal to feel a little chest tightness, chest pain, and slight pain in the armpit incision after the surgery for hand sweating. Do not touch water before removing the stitches on both sides of the wounds, and if you accidentally get it wet, you should change the sterilized gauze immediately to keep the wounds dry. On the 8th-9th day after surgery, go to the local health center or hospital outpatient clinic to remove the stitches. You can bathe 2 days after the stitches are removed. What is primary hyperhidrosis? A: Hyperhidrosis caused by excessive sympathetic hyperactivity, rather than by disease in other tissues or organs, is called primary hyperhidrosis in medical terms. The vast majority of hyperhidrosis patients suffer from this type of hyperhidrosis. Although it does not affect the health of the body, it brings great inconvenience and disturbance in life. This is the most suitable indication for thoracoscopic thoracic sympathectomy/closure. What is secondary hyperhidrosis? A: There are a few people who have increased sweating due to diseases of other tissues and organs in the body, which is called secondary hyperhidrosis, such as hyperthyroidism, endocrine diseases, mental illness, traumatic brain and spinal cord tumors, and endocrine imbalance during menopause, etc. This is the most common form of hyperhidrosis. This type of excessive sweating due to diseases of other tissues and organs must be treated for the disease itself and is not a candidate for sympathetic nerve surgery.