Thorascopic sympathectomy and splanchnicectomy are most often performed for socially disabling palmar or axillary hyperhidrosis. Less common indications include Raynaud’s syndrome and chronic pain. The procedure is generally performed on both sides at a single operative setting.

The more extensive the sympathectomy, the greater the risk of compensatory sweating in other areas of the body (trunk, lower extremities). This can occur in up to 20% of patients. Therefore, most surgeons will limit the extent of ablation or resection to the least number of ganglia possible. Some surgeons will clip, rather than ablate or resect, the portion of chain, thus allowing reversal by clip removal should disabling side effects occur.

Visceral pain (e.g., from chronic pancreatitis) is a rare indication for denervation of the splanchnic nerves, termed a splanchnicectomy. This procedure requires dissection at a lower level than that required for hyperhidrosis or Raynaud’s syndrome. The sympathetic trunks are not divided. Splanchnicectomy has largely been superseded by percutaneous radiologic-guided ablation. It is described briefly here.