Video-Assisted Thoracic Surgery (VATS) sympathectomy is a safe and effective procedure
for treatment of facial, palmar and axillary hyperhidrosis. It can be more rarely used in other conditions.
Awake thoracic surgery with epidural anesthesia and spontaneous ventilation has been employed to
perform many surgical procedures including VATS sympathectomy.
This chapter describes the anatomy of the nerve with the most frequent abnormalities, the indications
and contraindication for both sympathectomy and awake surgery, the method for awake anesthesia, a
detailed step-by-step description of the surgical technique and postoperative management as well as an
analysis of benefits and potential side-effects of awake VATS sympathectomy.
Patient selection, choice of the level of sympathectomy and adequate information about anesthesia and
side effects of the operation are extremely important for the good result of the procedure.
Awake VATS sympathectomy may be considered a globally minimally invasive approach combining
avoidance of general anesthesia-related adverse effects with maximum patient satisfaction.
Keywords: Sympathectomy, VATS, awake thoracic surgery, hyperhidrosis, local anesthesia, thoracic
epidural anesthesia.
