What is the principle of sympathetic nerve surgery for hand sweating? The body’s sweat glands are innervated by sympathetic nerves (which are a type of visceral nerve), and the glands secrete when the nerves are excited in order to produce sweat. Different parts of the skin are innervated by different sympathetic nerves. Hand sweating is a focal hyperhidrosis and can be treated by removing the sympathetic nerves that reach the palms of the hands. The sympathetic nerve that governs the palm of the hand originates from the chest, so a minimally invasive thoracoscopic procedure that cuts the thoracic sympathetic nerve that governs the palm of the hand at a specific site can effectively treat hand sweating. What are the results of hand sweating surgery? Thoracoscopic sympathetic nerve surgery is currently the only treatment for hand sweating that has good lasting results. For hyperhidrosis of the palms, the overall effectiveness rate is over 95%. For axillary hyperhidrosis, with a good choice of surgical approach, the effectiveness rate can also approach 90%. Foot sweating is not as effective, with only a few patients experiencing a reduction. What is the safety of hand sweating surgery? Safety is fundamental to the existence of any treatment. The sympathetic nerves are located deep inside the thoracic cavity, on both sides of the spine, so the surgery needs to be done under general anesthesia to be the safest. During the surgery, instruments and endoscopes are used to enter the chest cavity, pushing through the lung tissue to see and cut the sympathetic nerve. So strictly speaking there is some danger. Especially when there are adhesions between the lung tissue and the chest wall, it may damage the lung tissue and cause complications such as pneumothorax and hemothorax. There are also other dangers such as anesthesia complications, cardiovascular complications, and intercostal vascular bleeding. However, overall, it is a minimally invasive surgery with relatively high safety. As long as the operation is standardized, the probability of occurrence of the above-mentioned dangerous conditions and complications is still very low. How to reduce or avoid risks, I think we need to pay attention to two aspects: first. The experience of the doctor and the overall strength of the hospital are important. Objectively speaking, the technical threshold of this procedure is not very high, so many small hospitals are trying to carry out it, even including some local Chinese medicine hospitals and small clinics. They often have limited experience, and very small aspects of the treatment process can be a mistake, in addition to insufficient knowledge of the nerve, affecting medical safety and the final result. Second. Don’t believe in all kinds of eye-catching so-called “new” methods. The sympathetic nerve chain is located inside the chest cavity, and the operation is completed by gently cutting the nerve under safe anesthesia using a minimal incision. This is a most reasonable approach. Some units and doctors, in order to attract patients, create various so-called “innovative” gimmicks. In fact, it is often the case that they are seeking farther and farther away from the easy and the difficult, which in turn increases the risk of surgery and affects the safety of surgery. We hope that you will be able to identify and choose wisely. What are the side effects of hand sweating surgery? The sympathetic nerve is an important structure in the body with complex functions, and surgery to sever this tissue is bound to produce some side effects. But what are they and are they serious? are of great concern to sufferers. So far, the main side effects that have been observed are compensatory excessive sweating of the trunk, and individual patients will have excessively dry palms. Some patients may have some postoperative pain in the chest and back and a little numbness near the incision, but all recover gradually. Other effects, such as those on cardiopulmonary function, are theoretically possible, but from current studies are at a subclinical level, i.e., very mild. The most important factor influencing whether side effects occur and how severe they are is the degree of sympathetic interference with the surgery. The reason why the previous surgical methods such as T2 dissection were so powerful in compensating for excessive sweating was because of the wide range and severity of sympathetic de-sympatheticization (sympathetic nerves emanate from a section of the spinal cord and gradually rise to the neck and upper extremities, and the higher the cut means that more nerve conduction does not go up). Later, it was improved to T3 and then to T4, which can achieve the desympatheticization of the palm and ensure the efficacy, while basically not affecting other parts and organs, and the problem of compensatory hyperhidrosis is obviously reduced, or even disappeared to a large extent. Therefore, it is a more ideal procedure. My personal opinion is that as long as the efficacy can be guaranteed, the less interference with the nerves must be the better. This is why I advocate lowering the location of the cut. The question of whether T3 or T4 should be cut for hand sweating surgery is often discussed. The first thing that must be said is that both types of surgery are effective methods of treatment for hand sweating, and the differences are not too great, but each has its own characteristics. The biggest advantage of T4 excision is that compensatory hyperhidrosis is minimal, and the symptoms are mild, so there is basically nothing to worry about. I personally prefer the T4 cut. Of course, if the patient insists on having T3 cut off, it is perfectly fine. There is no difference in the difficulty of the two procedures. Sometimes there are very special cases, that is, the original plan is to do T4, but after going in, we see that the blood vessels and nerves near T4 are close together and cannot be separated, so in order to avoid bleeding, we temporarily change to T3 dissection. There are also cases in which the T3 is temporarily changed to T4. About the difference between T3 and T4, I think we can understand that both are the same kind of medicine, T3 is equivalent to the amount of 2 tablets, T4 is equivalent to the amount of 1 and a half tablets. If you can take 1.5 tablets to achieve 95% efficiency, and it is safe and has mild side effects, then taking 1.5 tablets is fine. You say I am looking for 100% effectiveness, then take 2 tablets, but the side effects of 2 tablets are bigger and heavier (in this procedure is mainly compensatory sweating), and this side effect is lifelong and there is no way to treat it. This is very troublesome. Just like there used to be a drug called streptomycin, which is a good antibacterial, but when used too much it can produce ototoxicity and lead to irreversible hearing loss. This is very troublesome. What to do with a little sweating again after surgery There are two cases, one is that some patients have sudden sweating of the hands about 1 week after surgery, which disappears on its own or reduces significantly after a few days, this is called “postoperative transient sweating”, which has been reported all over the world, and we have encountered many of them, both T3 and T4. The cause is not completely clear. But there is absolutely nothing to worry about, it is a temporary phenomenon. There is another situation, that is, the hand sweating is reduced after the surgery compared to the pre-operative period, but there will still be some, as long as it is not heavy and normal work life is not affected much, you can leave it alone. You don’t have to worry about it getting heavier and heavier and going back to the way it was before surgery, that is unlikely. We have noticed that some patients have been dry hands after surgery, suddenly a little sweating, nervous, thought it would be a relapse, thought it would get heavier and heavier, but after a few months found that there is no trend of aggravation, out of the point, nothing affects, so they are also frank. Of course, there are a very small number of patients who have recurrence of hand sweating after surgery, months or years later. We have encountered patients with T3 cut and T4 cut who may have them. The reason why they relapse is very unclear. In fact, just like taking medicine, even the best medicine, it is difficult to be 100% effective, especially 100% effective for life. If a relapse does occur and the symptoms are severe enough to interfere with normal life and work, it can be treated by reoperation. I often think that one of the most basic bottom lines in treating people is not to “get rid of old diseases and add new ones”. Compensatory hyperhidrosis is one of the more common side effects of sympathetic nerve surgery, and if the symptoms are severe, it can become a very uncomfortable new problem. If the results are poor after surgery (the probability of occurrence is actually very low), there is still something we can do (another surgery). But if there is severe compensatory hyperhidrosis after surgery, there is nothing we can do, at least for now. It doesn’t matter if you have a problem, but if you have a problem without a solution! Therefore, it is very important to consider how to reduce or even avoid this side effect for the doctors who carry out this technique. Some doctors repeatedly tell their patients before surgery that people always sweat, and when the palms of the hands are not out, the sweating of the torso must increase. The patient, out of the urgency of treatment, admits to the compensatory sweating that occurs after surgery. However, after a long time, the pain of the original hand sweating is gradually forgotten, and the problem of compensatory body sweating gradually emerges and becomes a new problem, and some especially serious ones even regret having the surgery. How to prevent compensatory hyperhidrosis, the most central approach is to reduce the location of the cut sympathetic nerve, T4 cut compensatory sweating is very light, basically do not worry. This is a problem confirmed by our experience and practice at home and abroad.