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The sympathetic nervous system is part of the autonomic nervous system. The autonomic nervous system controls the body's unconscious actions - it is automatic. 

The sympathetic nervous system regulates the body by sending signals to organs. Most organs in the body have connections to the sympathetic nervous system. 

In particular, the sympathetic nervous system sends signals to prepare the body for "fight-or-flight;" that is, to prepare the body for immediate action, in response to a threat to survival or to stress. 

In some cases, the sympathetic regulation of sweating can become dysfunctional, leading to excess sweating. This excess sweating is termed hyperhidrosis

To be fair, the true cause of hyperhidrosis is often unknown. Two types of hyperhidrosis exist: primary and secondary. 

Primary hyperhidrosis is usually localized to an area, such as the hands (palmar hyperhidrosis), face, scalp, underarms, soles. 

Secondary hyperhidrosis is due to another cause or underlying condition and typically involves excessive sweating of the whole body. Underlying factors can include infection, medications, thyroid disease, or cancer.  

There can be many contributing factors which make hyperhidrosis worse, such as caffeine, nicotine, or anxiety.

Several methods of therapy can be undertaken for hyperhidrosis. 

Topical agents may be applied to affected areas. These tend to be short-acting and of limited usefulness for patients with severe hyperhidrosis. Skin irritation can result if multiple daily applications are undertaken. 

Medications are also an option. Anticholinergic medications such as Ditropan may be helpful, especially for patients whose sweating is often exacerbated by anxiety. Side effects such as dry mouth and constipation may result. 

Botulinum toxin aka Botox can be injected, in order to block the neural input to sweat glands. Many patients have positive results, which can last 9-12 months. Repeated injections are often needed. 

Surgery can be performed when other treatment options fail. Sweat glands can be removed, mostly for underarm cases.


Thoracic sympathectomy can be performed, which interrupts neural input to the sweat glands. 

If thoracic sympathectomy is needed, a minimally-invasive method is usually used. 




A robotic method can be used for sympathectomy. 

The method Dr. Pool uses involves 3 small incisions between the ribs, on the side of the chest. The ribs are not broken. 

The incisions are performed on the side affected by the hyperhidrosis, which in many cases is both sides. 

The sympathetic chain is cut or clamped, interrupting signals to the sweat glands. 

It usually takes Dr. Pool about 1 hour to perform a robotic sympathectomy.

Most patients who undergo robotic sympathectomy go home the next day. 

The majority of patients have relief from their excessive sweating and reports satisfaction with the operation. However, an important issue post-op is the possibility of compensatory sweating. Compensatory sweating refers to excessive sweating that occurs in an area previously unaffected. 

Compensatory sweating is not troublesome for some patients but may be worse than the original sweating for some patients. 

It is estimated that around 3% of people have hyperhidrosis. It affects men and women equally. 

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