New hyperhidrosis center at Cedars-Sinai offers relief from excessive sweating

November 25, 2000

LOS ANGELES (Nov. 20, 2000) -- Cedars-Sinai Medical Center and Martin Cooper, M.D., clinical chief of neurosurgery, have joined forces to help patients who suffer from a disorder that causes uncontrollable sweating of the hands, feet and sometimes underarms.

Dr. Cooper, who has nearly 30 years of experience in treating the condition - called hyperhidrosis - wants patients to know that a minimally invasive procedure can provide a lasting cure.

"Hyperhidrosis is not a life-threatening disease but it often has a devastating impact socially and economically," said Dr. Cooper, director of the hospital's new Hyperhidrosis Center. "People with the condition tend to avoid situations where they will come into contact with others. We've had patients in the past who have undergone a variety of medical modalities, including psychotherapy, radiation therapy, physical therapy, oral medication, and the application of local solutions to their hands, but nothing works. The most definitive way of curing this condition is by sympathectomy."

Dr. Cooper began seeing patients with the condition in the early 1970s while completing a fellowship at the Cleveland Clinic Foundation. Surgeons at that time were performing a grueling operation to remove a part of the chain of the sympathetic nerves that ran in the chest cavity. By taking out the section called the T2 ganglion and sometimes the T3 ganglion, the surgeons were able to permanently stop the excessive sweating of the hands and feet.

"The previous operation was a long, arduous and painful procedure, both for the surgeon and the patient," said Dr. Cooper. "Following the surgery, the patient would be transferred to an intensive care unit and they would remain in the hospital for several days."

Dr. Cooper performed this difficult procedure hundreds of times at the Cleveland Clinic and later at Cedars-Sinai Medical Center. Several years ago, he and a thoracic surgeon began using a technique that took advantage of technological advances in surgical instrumentation.

Today the procedure is performed endoscopically, with four tiny incisions, and complete recovery is measured in several days. Dr. Cooper uses a 3-millimeter scope with a camera lens on the end, and an instrument called a harmonic scalpel that vibrates so quickly it cuts tissue and cauterizes instantly to stop bleeding. Few if any other surgeons performing this operation - called video-assisted thoracoscopic sympathectomy or VATS - use the harmonic scalpel, which is extremely precise and minimizes damage to surrounding tissues.

After the patient is anesthetized, the surgeons make two small incisions on each side of the body. The harmonic scalpel is placed through one opening and the camera lens through the other, providing sharp, detailed images of the surgical site in question on high-definition monitors.

"The thoracic surgeon works through one portal and I work through the other," said Dr. Cooper. "We are able to visualize the chain of nerves, which was extremely difficult to see in the open procedure. The chain removal usually takes approximately five to 10 minutes through these small openings, with the entire procedure taking less than an hour. The patient returns to a regular room and is discharged that day."

Dr. Cooper, who has been at Cedars-Sinai since 1976, said the incisions are so small that sutures are unnecessary. Surgical glue holds the skin together, leaving only a tiny scar. "We usually do the procedure on a Thursday or Friday so that if patients feel well enough over the weekend, they can go back to work on Monday," he said. "Previously, people may have been off for a month."

Deborah Wills, a 34-year-old resident of Los Angeles, had dealt with the embarrassment of excessive sweating all her life but had been offered no hope by physicians she consulted. "I did not know that there was a name for this condition until just this year," said Deborah. "I've had this ever since I was a young child. I assume most people just live with it, as I did, because you don't realize that it's something that can be fixed. I went to doctors who said, 'That's just the way it is. You're going to have to deal with it.' But as I got older, it got somewhat worse and it caused my hands and feet to swell. That's what concerned me most."

Finally, about five months ago, she had an appointment with an internist who recognized the symptoms of hyperhidrosis as soon as he shook Deborah's hand. He referred her to Dr. Cooper. Before her appointment, however, Deborah prayed for guidance and conducted her own Internet research to understand as much as she could about the condition and the surgery.

"Then I met Dr. Cooper and we sat down and talked. As a matter of fact, we talked on the phone two or three times," she said. "Once I met him, I was pretty much ready at that point."

Deborah, who works three days a week as a communications dispatcher, arranged to have several days off to rest and recuperate. "Everyone's body responds differently, and your body will tell you what it needs to do in the healing process," said Deborah. Noting that she is petite and had never even had a broken bone before, she said she appreciated having a period of time to bounce back.

"I feel fantastic and if I had it to do all over again, I would," she said. "The problem is fixed. My hands aren't sweating and I can do things that other people take for granted." Even her selection of shoes has increased because she previously could not wear certain kinds of leather without having her sweaty feet slip.

"When you live with this type of disorder, you don't even notice that you're doing it but you avoid touching other people's hands," she said. "You're always talking about it. 'I'm so sorry I'm sweaty.' And you're always trying to minimize the problem or hide it. So you're always wiping your hands or you find yourself holding a napkin in your hand."

While she is generally a confident person, she said other people's comments would feed her insecurity about sweating. "People always made comments about it, not that they were being hurtful. I don't believe that was their intent, but they always brought notice to it. 'Your hands are sweaty. Don't touch me with those hands.' That kind of thing."

According to Dr. Cooper, hyperhidrosis affects people of all nationalities, and about 40 percent of those diagnosed with it have some family member who also suffers from it. Furthermore, despite patients' hopes and prayers, no medical solutions prove effective and the condition does not go away on its own. He has performed thoracoscopic sympathectomies on patients of all walks of life and virtually all ages - from the teen-age years to the 60s.

"This is the happiest group of patients because this disorder really affects every aspect of their lives and is easily curable," Dr. Cooper said.
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Cedars-Sinai Medical Center

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