Risks & Possible Complications
VATS Sympathectomy (ETS)
What the published evidence says about risk
This page summarizes the risks of VATS sympathectomy for hyperhidrosis in plain language, using figures reported in published studies. This is general information, not your individual risk assessment — Dr. Irshad will review your own risk factors and expectations with you directly as part of your consent discussion before surgery. The single most important risk to understand for this operation is compensatory sweating, discussed below.
Risks & possible complications
- Compensatory sweating — common. New or increased sweating elsewhere on the body (usually the back, abdomen, or thighs) affects roughly half of patients to some degree; about 1 in 4 to 1 in 10 describe it as severe enough to bother them. This is the main reason some patients regret the surgery, so it is worth discussing your personal risk tolerance with Dr. Irshad beforehand.
- Death — essentially none reported in modern published series.
- Collapsed lung (pneumothorax) — roughly 1.5–4%. Usually small and managed without a chest tube; occasionally needs one overnight.
- Bleeding — under 1%.
- Horner's syndrome (a slightly drooping eyelid and smaller pupil on one side) — rare, well under 1%, and usually temporary.
- Gustatory sweating (sweating while eating) — reported anywhere from under 1% to much higher depending on how much of the nerve chain is treated; less common with the lower, more targeted levels used today.
- Sweating returning in the treated area over time — roughly 4–7%, a bit higher when only underarm sweating was treated.
Your own risk varies. Compensatory sweating risk is influenced by how many nerve levels are treated and your body type. Ask Dr. Irshad how the planned extent of surgery affects your personal risk.
References
- Rodríguez PM, Freixinet JL, Hussein M, et al. Side effects, complications and outcome of thoracoscopic sympathectomy for palmar and axillary hyperhidrosis in 406 patients. Eur J Cardiothorac Surg. 2008;34(3):514–9.
- Öncel M, Sunam GS, Erdem E, et al. Bilateral thoracoscopic sympathectomy for primary hyperhidrosis: a review of 335 cases. Cardiovasc J Afr. 2013;24(4):137–40.
- Lin ZY, Lin M. Which patients are more likely to experience compensatory hyperhidrosis after endoscopic thoracic sympathectomy: a meta-analysis and systematic review. PeerJ. 2025;13:e19097.
- Schmidt J, Bechara FG, Altmeyer P, Zirngibl H. Endoscopic thoracic sympathectomy for severe hyperhidrosis: impact of restrictive denervation on compensatory sweating. Ann Thorac Surg. 2006;81(3):1048–55. PubMed
Common questions about risk
What is compensatory sweating after ETS surgery?
Compensatory sweating is new or increased sweating elsewhere on the body — usually the back, abdomen, or thighs — after endoscopic thoracic sympathectomy (ETS). It affects roughly half of patients to some degree, and about 1 in 4 to 1 in 10 describe it as severe enough to bother them.
Is VATS sympathectomy for hyperhidrosis a dangerous surgery?
No — death has essentially never been reported in modern published series of VATS sympathectomy. The main risk to weigh before surgery is compensatory sweating, not a life-threatening complication.
How common is a collapsed lung after sympathectomy?
A collapsed lung (pneumothorax) occurs in roughly 1.5–4% of cases, and is usually small and managed without a chest tube.
Does sweating come back after sympathectomy?
Sweating returns in the originally treated area in roughly 4–7% of patients over time, somewhat higher when only underarm sweating was treated.
This page is general information, not medical advice or a consent form. It does not replace the individualized consent discussion you will have with Dr. Irshad, which accounts for your own health, anatomy, and the specific operation planned. If you are experiencing a medical emergency, call 911 or go to your nearest Emergency Department immediately. Published in compliance with the CPSO Advertising Standards Policy.
Questions about your risk?
Dr. Kashif Irshad — Division of Thoracic Surgery, William Osler Health System, Brampton Civic Hospital. Tel: (905) 458-4520 · Fax: (905) 458-4080 · thoracic@williamoslerhs.ca
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