Skip to Content

Micro-Invasive Endoscopic Sympathectomy

An endoscopic sympathectomy is a surgery on the nerves that's less invasive than standard techniques. It treats health issues caused by overactive sweat glands.

Special nerve fibers along the spinal cord activate these sweat glands. These are the sympathetic chain. The surgery stops nerve signals from the spine from turning on the sweat glands.

On this page:

What Is an Endoscopic Sympathectomy?

An endoscopic sympathectomy is a spinal surgery on the nerves that uses less-invasive techniques.

The doctor operates on a bundle of nerves all along the side of the spinal cord called the sympathetic chain. The sympathetic chain has three sections, all of which are accessible using this type of surgery:

  • Cervical chain in the neck.
  • Thoracic chain in the chest.
  • Lumbar chain in the lower back.

The surgery uses an endoscope — a tube that lets the doctor operate through two small cuts instead of a large opening. The endoscope has a video camera and a light that allows them to see what they're doing. In the second cut, the surgeon can feed tools to do their work.

This state-of-the-art approach makes for a quicker and more comfortable recovery. 

Back to top.


Why Would I Need an Endoscopic Sympathectomy?

An endoscopic sympathectomy can treat health issues caused by overactive sweat glands. These include the following:

  • Excessive sweating, called hyperhidrosis.
  • Facial blushing.
  • Social phobia.
  • Blood flow issues caused by Raynaud's disease.
  • Reflex sympathetic dystrophy, a type of complex regional pain syndrome.

This technique also treats other health issues caused by damage to these nerves.

Who is a candidate for an endoscopic sympathectomy?

Endoscopic sympathectomy is for people with excessive sweating or other health issues related to the sympathetic chain. An ideal candidate sweats so much they are uncomfortable to the point where it limits the activities they can enjoy. It can also include people who experience excessive sweating after trying all other treatments. 

Back to top.


What Are the Risks and Complications of an Endoscopic Sympathectomy?

All procedures carry some degree of risk, such as with anesthesia, infection, bleeding, and blood clots.

According to the National Library of Medicine, complications of an endoscopic sympathectomy can include:

  • Compensatory sweating— Sweating in a new site on your body.
  • Hemothorax — When blood collects in the chest.
  • Horner syndrome — A rare condition that involves droopy eyelids and decreased sweating in the facial area.
  • Pneumothorax — When air collects in the chest. 

Back to top.


What Should I Expect From an Endoscopic Sympathectomy?

Before: How to prepare for an endoscopic sympathectomy

Before your procedure, your doctor will tell you what medicines you can take in the days leading up to your surgery and the morning of the procedure. They will also let you know when to stop eating or
Since doctors use general anesthesia to put people having endoscopic surgery to sleep, you will need someone to drive you home following the procedure.

During your endoscopic sympathectomy

During the surgery, the surgeon makes a tiny incision in the back and inserts two small instruments. The endoscope in one shows the surgeon what they're doing on a monitor in the operating room. They use a dissecting tool through the other incision to clamp off nerves.

The surgeon uses clamps to shut off the nerves rather than taking them out. The clamps let the doctor reverse it if side effects are a problem. Though the need for reversal is rare, using clamps gives people this option.

Recovery after an endoscopic sympathectomy

Most people leave the hospital within hours after the surgery. They typically have a minimal recovery period.

People who get endoscopic sympathectomy have sight soreness and bruising around the incisions. Most people can get back to normal activities within one to two weeks. 

Back to top.


Medically reviewed by John J. Moossy, MD on 9-10-24.