Endoscopic thoracic sympathectomy

Definition

Endoscopic thoracic sympathectomy (ETS) is surgery to treat sweating that is much heavier than normal. This condition is called hyperhidrosis. Usually the surgery is used to treat sweating in the palms or face. The surgery stops or turns off the nerve signals that tell the part of the body to sweat too much.

Alternative Names

Sympathectomy - endoscopic thoracic; ETC

Description

You will receive general anesthesia before surgery. This will make you unconscious and unable to feel pain.

Your surgeon will make 2 or 3 tiny incisions (cuts) under one of your arms.

• Your lung on this side will be deflated (collapsed) so that air will not move in an out of it during surgery. This gives your surgeon more room to work.
• A tiny camera called an endoscope will be inserted into your chest. Video from the camera will show on a monitor in the operating room. Your surgeon will use the monitor to do your surgery.
• Your surgeon will insert other small tools through the other incisions.
• Using these tools, your surgeon will locate the nerves that control sweating in the problem area. These will be cut or destroyed.
• Your lung on this side will be inflated.
• Your surgeon will close your incisions with sutures (stitches).

After doing this procedure on one side of your body, your surgeon will do the same thing on the other side. The surgery takes about 1 hour total.

Why the Procedure Is Performed

This surgery is usually done on patients whose palms sweat much more heavily than normal. It may also be used to treat extreme sweating of the face. It is only used when other treatments have not worked.

Risks

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Bleeding
• Infection
• Heart attack or stroke during surgery

Risks for this procedure are:

• Damage to arteries or nerves
• Increased or new sweating
• Horner syndrome (decreased facial sweating and drooping eyelids)

Surgeons who perform ETS must receive special training. Before having this surgery, make sure your surgeon has this training.

Before the Procedure

Always tell your doctor or nurse:

• If you are or could be pregnant
• What drugs, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription

During the days before the surgery:

• You may be asked to stop taking drugs that make it hard for your blood to clot. Some of these are aspirin, ibuprofen (Advil, Motrin), vitamin E, and warfarin (Coumadin).
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help quitting.

On the day of your surgery:

• You will usually be asked not to drink or eat anything after midnight the night before surgery.
• Take the drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Most people stay in the hospital 1 night and go home the next day. You may have pain for about a week. Take pain medicine as your doctor told you to. You may be taking acetaminophen (Tylenol) or prescription pain medicine. Do not drive if you are taking narcotic pain medicine.

Keep your incision areas clean, dry, and covered with dressings (bandages). Wash the areas and change the dressings as your doctor told you to. Do not soak in a bathtub or hot tub, or go swimming, for about 2 weeks.

Slowly resume your regular activities as you are able to.

Your doctor will ask you to schedule a follow-up visit to inspect your incisions and to see if the surgery was successful.

Outlook (Prognosis)

This surgery improves the quality of life for most patients. It does not work as well for people who have very heavy armpit sweating. Some people may notice new sweating, but this may go away on its own.

References

Boley TM, Belangee KN, Markwell S, Hazelrigg SR. The Effect of Thoracoscopic Sympathectomy on Quality of Life and Symptom Management of Hyperhidrosis. Journal of the American College of Surgeons. March 2007;204(3).