Minimally invasive surgery ends decades of sweaty palms for one patient

For over twenty years, 22-year-old Ta Duy Khang struggled with the embarrassment of cold, sweaty palms. The condition was so severe that he often avoided shaking hands. After a quick five-minute endoscopic thoracic sympathectomy at FV Hospital, his palms became dry and his confidence returned.

Doctors at FV Hospital say that endoscopic thoracic surgery for palmar hyperhidrosis is now a routine, same-day procedure with a success rate close to 100%.

Mr Ta Duy Khang returned for his follow-up appointment two days later with completely dry palms. Image: FV

When a simple handshake becomes a source of anxiety

For most people, a handshake is a simple gesture, but for 22-year-old Ta Duy Khang from Vinh Long, it caused a lot of anxiety.

Khang had lived with palmar hyperhidrosis since he was a child. His hands were almost always ice-cold, bluish, and soaking wet. When he studied, sweat would soak through his exercise books. Before shaking hands, he would quietly wipe his palms on his clothes. After more than 20 years, this condition was much more than a nuisance. It became a real source of anxiety and left him feeling less confident.

At FV Hospital, he was seen by Dr Dang Dinh Minh Thanh, PhD     , Specialist Level II, Head of the Thoracic Surgery Department, who explained the underlying cause of his condition, the available treatment options, and in particular the endoscopic surgical technique for treating the sympathetic ganglia in the chest. Khang scheduled surgery without hesitation, hoping to finally free himself from a condition that had followed him for more than two decades.

Dr Dang Dinh Minh Thanh, PhD, Specialist Level II, advising on treatment for palmar hyperhidrosis. Image: FV

A 5mm incision: Dry palms and same-day discharge

The operation was over faster than Khang could ever have imagined. At FV, Dr Dang Dinh Minh Thanh reached the sympathetic ganglia through two small incisions, each about 5mm, in the armpit area. This replaced the need for open chest surgery. Treating both hands usually takes only about five minutes.

Just 30 seconds after the ganglion was treated, Khang’s hands started to change colour from bluish to a healthy pink. About an hour later, he woke up from anaesthesia. He did not need any pain medication and was able to go home just two hours after surgery.

Two days later, Khang came back for a follow-up visit. This time, his palms, which had always been cold and damp, were now completely dry.

“I’m so happy and relieved to be free of this condition. Dr Thanh was warm and attentive, and explained everything thoroughly, both before and after the surgery. From the moment I walked into the hospital, the administrative staff were there to support me with paperwork, right through from admission to discharge,” Khang said.

T3 Sympathectomy: A definitive solution for palmar hyperhidrosis

Dr Dang Dinh Minh Thanh explains that palmar hyperhidrosis is fairly common, affecting about 1% of people worldwide. Most cases are present from birth, and some get better as children grow up. The severity can range from slightly moist palms to sweat that drips from the palms.

School-age and university students are most often and most seriously affected. Many have such sweaty palms that their exercise books get soaked whenever they write. Some even have to wrap their pens in cloth just to be able to write.

There are several treatment options. Topical methods, like soaking the hands with an iontophoresis device, using creams, or getting Botox injections, can help reduce sweating but usually need to be repeated.

Another option is medication that affects the sympathetic nervous system. However, since the autonomic nervous system controls many body functions, these medicines can cause unwanted side effects.

According to the evidence, the most effective and definitive treatment is intervention on the sympathetic nervous system within the chest, said Dr Thanh. The sympathetic nervous system runs along the spine and governs sweat production in corresponding regions of the body. By accurately identifying and treating the specific sympathetic ganglion responsible for palmar sweating, the palms can become dry.

This surgical technique has changed a lot over time. In the past, surgeons treated several sympathetic ganglia at three levels: T2, T3, and T4. But this approach often made palms too dry and caused compensatory hyperhidrosis, which is increased sweating in other parts of the body.

Through experience, surgeons learned that treating only the T3 ganglion still made palms dry, but without making them too dry. It also greatly reduced the chance of compensatory hyperhidrosis. Because of this, single-level T3 sympathectomy is now the preferred method at FV, as it works well and has fewer side effects.

Dr Dang Dinh Minh Thanh, PhD, Specialist Level II, treating a patient for palmar hyperhidrosis. Image: FV

Instead of the open chest surgery used in the past, the procedure is now done with endoscopic thoracic surgery. At FV, surgeons reach the sympathetic ganglia through two small incisions, each about 5mm, in the armpit. This leaves smaller scars and looks much better than the old method. Surgery usually takes only about five minutes for both hands. After surgery, palms can quickly go from cold and damp to dry and healthy.

However, not every case of palmar hyperhidrosis needs surgery. Dr Thanh says that surgery can be considered from about age 15, but the best treatment depends on how severe the condition is and each patient’s unique situation.

For more information about treating palmar hyperhidrosis at FV Hospital, visit us at 6 Nguyen Luong Bang Street, Tan My Ward (formerly District 7), Ho Chi Minh City, or call (028) 3511 3333.