Dr. Reisfeld, one of the worlds top hyperhidrosis surgeons.

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The most effective type of surgery depends on the location and severity of a patient's focal hyperhidrosis.

1. For those who suffer primarily from severe and excessive hand sweating then endoscopic thoracic sympathectomy is most appropriate.
   Learn more about Endoscopic Thoracic Sympathectomy



2. For those who suffer from severe excessive plantar hyperhidrosis as their primary or only area of excessive sweating or for those patients who did not get any benefit from endoscopic thoracic sympathectomy for their foot sweating then lumbar sympathectomy is an appropriate procedure.
   Learn more about Lumbar Sympathectomy



3. For those patients who suffer primarily from excessive armpit sweating, axillary suction currettage is the appropriate procedure.
   Learn more about Suction Currettage



4. For those patients who suffer primarily from groin sweating visit our new groin sweating page to learn about the options available.

• ETS is the only procedure available that provides the possibility for a permanent solution to hyperhidrosis.
• The procedure is proven to be safe and effective.
• Dr. Reisfeld is highly experienced, performing the procedure on almost a daily basis.
• Patients are able to leave the same day of the procedure.
• Patients are able to return to their normal daily routine within a short time.

Details of the surgery (ETS - Endoscopic Thoracic Sympathectomy):

• Under general anesthesia, a small incision, approximately one centimeter (less than ½ inch) in length, is made under both armpits.
  Diagram: Sympathetic Nerve Diagram.
• Air is inserted through the incision into the chest cavity. The reason for the air is to push the lung away from the operative site. At no time does the lung collapse because we use single lumen intubation. This means that air is exchanged through both lungs throughout the entire procedure. Different ETS surgeons use different techniques including the use of double lumen endotracheal tubes, which in turn, leads to a collapsed lung. Even with a collapsed lung, however, the lung will go back to its normal position once it is inflated again.
• Endoscopic equipment (a fiber optic camera and a working instrument) is then inserted. Two high-resolution monitors are placed at either side of the patient so the doctor has a perfect view of the custom-made instruments he is using. The sympathetic chain is located along the rib's head.
• The sympathetic chain is located along the rib's head.
• The endoscopic instrument is used to clamp the T3 to T4 segment of the sympathetic nerve node responsible for the cause of excessive sweating. Four titanium clips are placed on each side of the nerve chain. Recently, during the last international conference held in Finland, a theory came about with regard to the exact level of performing the sympathectomy. In other words, the theory proposed the idea that lowering the level of the sympathectomy to T3 and T4 levels will in return reduce the amount of compensatory sweating. So far, my own experience performing T3 to T4 sympathectomy for hand sweating has shown lessening in the amount of severe compensatory sweating. The theoretical basis for this idea is the fact that most of the sympathetic innervation to the head area originates at a T2 level. Leaving this segment intact, renders more body surface (upper body) with sympathetic innervation which results in less compensatory sweating. More clinical studies will have to be performed in order to prove the relevance of clip placement. At the present time, for patients with the typical presentation of sweaty hands, sweaty feet, and armpit sweating, Dr. Reisfeld is doing the sympathectomy on the segment between the 3rd and the 4th rib. Thus far, the results are the same as with the classical T2 sympathectomy, yet there seems to be less compensatory sweating. More time and more clinical follow up will be required in order to prove this point in a more definite way. Dr.Reisfeld is happy to discuss this issue with every patient who wants to know more about the issues involved. Another question that was discussed at the conference was how different levels of sympathectomy might have an affect on facial blushing, facial sweating, and sweaty hands. This issue is an open question and more clinical trials are needed to substantiate any theory.
• Once the surgery is completed, the air is taken out and the lung returns to its normal position. The instruments are carefully removed.
• The incision is then sutured internally with absorbent sutures. This eliminates the necessity for sutures removal.
• The process is then repeated on the other side of the chest.
• At the present time, clamping is the procedure of choice and the one recommended by Dr. Reisfeld. The primary reason for using the clamping procedure is that it leaves the possibility for easier reversal, easier in the sense of technically and physiologically. In the cutting method, when a patient is unhappy with the results of the procedure a reversal may be done by performing a nerve graft operation. This procedure is very difficult to perform. In the clamping method, reversal is much easier because it simply requires removal of the clips and by doing so gives the nerve segment a possibility for regeneration. It has been shown that some patients having the clamps removed showed lessening of the compensatory sweating (compensatory hydrosis or reflex sweating) to total disappearance of the compensatory sweating.
• Patients who have an equal problem with the severity of their sweating in the hands and armpit area will benefit from the endoscopic thoracic sympathectomy on levels T3-T4-T5.
  
  In other words for those patients who explain that their excessive hand sweating is equal to their excessive armpit sweating adding sympathectomy at the T5 level will give them a higher chance of slowing down or eliminating their armpit problem as well. On the other hand if patients only have excessive armpit sweating Dr. Reisfeld's current opinion is that sympathectomy should not be done for isolated armpit sweating only.
• So far Dr. Reisfeld has performed approximately 35 clamp removal procedures. The results are not 100% but about 50% of those cases showed improvements in their clinical condition which translated into reduction of compensatory sweating, better exercise tolerance, re-appearance of sweat in the hands and upper body, etc. Obviously more time is needed to come to any definite conclusions and also we will need more cases so statistical analysis can be made.
• Most patients are able to walk out of the medical center within 2 hours after surgery. Regular physical activity and returning to work are possible in one week or less. Scarring is minimal as the incisions are small and well hidden in the folds of skin of the armpit.
• Dr. Reisfeld personally checks up with each of his patients post surgery to ensure they are perfectly taken care of and to answer any and all of their questions. Dr. Reisfeld takes pride in his excellent patient care; this is very evident by reading any of the patient testimonials. To read what patients, from all walks of life have to say about Dr. Reisfeld, click here.

To learn more about how this life changing procedure could possibly help you please contact us.

Do you have a question that is not answered here? Just ask and we will answer. To ask your question click here.

Lumbar Sympathectomy: Anatomical drawing showing where the incisions are made.

In this procedure an access is being made to the sympathetic chain that runs along the lumbar vertebrae. The operation is done under general anesthesia and it takes about 2 hours. The patients are staying overnight at the hospital.

As more experience is gained even lumbar sympathectomy can be performed on an outpatient basis. In a typical case like this if the operation starts early in the morning, and the anatomical relations are displayed easily and nicely, the resultant pain and discomfort can be brought down to a minimum enabling a patient like this to leave the hospital in the late afternoon. Many more cases will have to be done in order to establish a definite pattern which would allow us to do the majority of the cases on an outpatient basis. It should be re-emphasized again that because this is a more challenging operation for the surgeon (not the patient) some patients may need a slightly longer stay at the hospital. Travel plans need to be adjusted accordingly.

Basically the operation can be done endoscopically. In this approach there are three small cuts made on the side of the abdomen (flank region). And through those cuts endoscopic equipment is being inserted, a space behind the stomach is developed and then the sympathetic chain running along the lumbar vertebrae is located. The sympathetic chain is then clamped below the level of the second lumbar vertebra. It is important to be in that level to reduce the chances of side effects. In some cases there is a necessity to convert the operation from an endoscopic approach to an open approach and the only difference is that one of the incisions is slightly longer. The amount of pain and the time spent at the hospital are the same. The operation has about a 95% success rate and it can help those patients where plantar hyperhidrosis is a major problem.

To learn more about how this life changing procedure could possibly help you, please contact us.

Do you have a question that is not answered here? Just ask and we will answer. To ask your question click here.

Axillary Suction Currettage for Excessive Armpit Sweating:
Excessive armpit sweating beyond the normal physiological needs can be bothersome, unpleasant and debilitating. This can happen as a primary presentation of focal hyperhidrosis with or without excessive hand sweating. There are numerous conservative antiperspirants on the market and obviously those should be the first approaches tried to deal with this problem. If those over the counter products are ineffective then there are products containing aluminum chloride ingredients that can help. They come in different strengths, some such as Maxim can be purchased online and those with the highest concentration of aluminum chloride can be obtained with a prescription.

Surgical solutions for excessive armpit sweating were available for many years. Basically those procedures involved cutting the skin from the armpit area. It was a good solution but it created big scars and sometimes scarring that prevented a full range of motion in the armpit/shoulder area. Over the last few years Botox injections became a fashionable solution but a major drawback to the Botox injection was the temporary nature of the help they provided.

Axillary suction currettage came to light over last few years. In this particular procedure very small cannulas are inserted underneath the skin and with repeated criss cross motions the sweat glands are removed from their location in the superficial layers underneath the skin. The operation is being carried out under light general anesthesia. The operation takes about an hour. The pain and the scarring are minimal and patients are able to resume normal activity after a very short time. Side effects such as bleeding, infection, swelling and fluid accumulation can happen but will go away. Wrinkling of the skin in the armpit area is common but with time it smoothes itself out.

To learn more about how this life changing procedure could possibly help you please contact us.

Do you have a question that is not answered here? Just ask and we will answer. To ask your question click here.

It is important to note that patients should always try conservative methods and consult with their doctors before embarking on a surgical approach.

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