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Hyperhidrosis

Hyperhidrosis Surgery
ETS Treatment for Excessive Sweating, London

Endoscopic thoracic sympathectomy (ETS) — a highly effective keyhole procedure for primary hyperhidrosis affecting the hands, armpits, or face. Over 95% success rate for palmar sweating. Single small incision each side of the chest. Most patients stay overnight. London Bridge Hospital and Lister Hospital Chelsea. Surgery is considered after non-surgical options have been tried. Excessive sweating symptom page →

Last reviewed: May 2026 · Dr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382

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Procedure

Endoscopic Thoracic Sympathectomy (ETS) — keyhole interruption of the sympathetic nerve chain responsible for sweating. Single small incision each side of the chest. Overnight stay

Success rate

Over 95% for palmar (hand) hyperhidrosis. Effect is immediate — most patients wake from anaesthesia with dry hands for the first time. Relief typically felt within days

Key consideration

Compensatory sweating — increased sweating elsewhere on the body — occurs in most patients to some degree and is discussed fully at consultation. Surgery after non-surgical options fail

About the Procedure

What Is
Endoscopic Thoracic Sympathectomy?

Primary hyperhidrosis is caused by overactivity of the sympathetic nervous system. Endoscopic thoracic sympathectomy (ETS) is a minimally invasive keyhole procedure that interrupts the relevant segment of the sympathetic chain through a single small incision on each side of the chest, performed under general anaesthesia.

ETS is most effective for palmar (hand) and facial hyperhidrosis, with published success rates above 95%. The effect is typically immediate — patients wake from surgery with dry hands for the first time. Surgery is considered after non-surgical treatments, including antiperspirants, iontophoresis, and Botox injections, have been tried and found insufficient.

The main side effect to discuss is compensatory sweating — increased sweating elsewhere on the body, most commonly the trunk. This is mild and acceptable in the majority of patients. All aspects of the procedure, including risks and realistic expectations, are discussed fully at consultation before any decision is made.

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Types of Hyperhidrosis Treated
  • →Palmar hyperhidrosis (excessive hand sweating)
  • →Axillary hyperhidrosis (excessive armpit sweating)
  • →Facial hyperhidrosis and facial blushing
  • →Combined palmar and axillary hyperhidrosis

Referrals accepted from GPs, dermatologists, and self-referrals. Excessive sweating symptom page →

Procedure & Recovery

ETS is performed with a single small incision each side of the chest under general anaesthesia. The procedure takes approximately 30–45 minutes. Most patients stay overnight in hospital. Return to desk work is typically within 3–5 days and to light physical activity within 2 weeks. Relief is typically felt within days of surgery.

Insurers Accepted

BUPA, AXA Health, Aviva, WPA, Cigna, and BUPA International. Please contact Jo Mitchelson to confirm your specific cover: 020 7952 2882.

Frequently Asked Questions

Questions About
Hyperhidrosis Surgery

Below are the questions patients most commonly ask about ETS surgery for hyperhidrosis. See also the excessive sweating symptom page →

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Or call Jo Mitchelson:
020 7952 2882

Is ETS surgery permanent?
Yes, in the vast majority of cases. ETS involves dividing or clamping the sympathetic nerve fibres, which produces a permanent effect. The improvement in palmar and facial sweating is immediate and lasting. Unlike Botox injections, which require repeated treatment, ETS is a one-time procedure.
What is compensatory sweating?
Compensatory sweating is increased sweating in other areas of the body — most commonly the trunk, back, or thighs — that occurs as a result of ETS. It is experienced by the majority of patients to some degree. In most cases it is mild and acceptable, particularly when weighed against the improvement in palmar or facial sweating. In a minority it can be more significant. This is always discussed in full at consultation before any decision to proceed.
How quickly does the effect occur?
The effect is typically immediate. Most patients wake from surgery with dry hands for the first time. The improvement in facial blushing and sweating is equally rapid, with relief typically felt within days of surgery.
What is the recovery time?
Most patients stay overnight in hospital. Return to desk work is typically within 3–5 days; light physical activity within 1–2 weeks. General anaesthesia is required, so you will need someone to take you home and stay with you on the first night.
Do I need a GP referral?
No. Self-referrals are welcome for private consultations, as are referrals from GPs and dermatologists. Appointments are typically available within 2–3 days.

Book a Consultation

Appointments within 2–3 days. Self-referrals welcome.

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Jo Mitchelson, Private PA  · 020 7952 2882 · pa@lungsurgeon.co.uk

St Thomas' Hospital #1 UK · Guy's Hospital #2 UK · London Bridge Hospital #10 UK · Newsweek World’s Best Hospitals 2026

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