Sympathectomy involves cauterizing and removing a portion of the sympathetic nerve chain T2-4 that runs down the back inside the chest, parallel to the spine. This operation permanently interrupts the nerve signal that is causing the body to sweat excessively. Starting on one side of the body, the anesthesiologist deflates the lung so that the surgeon will be able to get to the sympathetic nerve chain. He or she makes one or two small incisions underneath the armpit, usually between the second and third ribs.

A small camera device, or videoscope called thoracoscope in this case, is placed through the incision in order to see inside the chest and identify the sympathetic nerve chain. Through the scope, a cautery device to cut and seal the appropriate level, as determined in advance by the patient's symptoms, is placed.

Patients with severe hyperhidrosis who have exhausted other medical treatments are finding that the thoracoscopic sympathectomy surgery offers a permanent solution to their problem. In almost all cases, it cures excessive sweating in the hands and underarms, and many people experience the side benefit of decreased sweating in the feet. Moreover, the effect of the surgery is often immediate. Patients are often amazed when they wake up and find their hands warm and dry for the first time in years.

The risks associated with the thoracoscopic sympathectomy procedure are minimal, but still need to be taken into account. Many patient have reported experiencing side effects, either as a result of the procedure itself or from complications that may occur during the surgery.