Endoscopic Thoracic Sympathectomy

Written by Natalie Phillips | Published on July 19, 2012
Medically Reviewed by George Krucik, MD

What Is Endoscopic Thoracic Sympathectomy?

Endoscopic thoracic sympathectomy (ETS) is surgery to treat hyperhidrosis—a medical condition characterized by heavy, uncontrollable sweating. ETS may also be performed to treat excessive facial flushing.

The surgery involves cutting the sympathetic nerves, which control sweating. An endoscope (a tiny, specialized camera) is used to locate the nerves.

Why Is Endoscopic Thoracic Sympathectomy Performed?

ETS is usually done for patients who sweat too much. These individuals may experience excessive sweating of the hands, feet, or armpits. This condition can cause social and physical discomfort. The surgery is also used to treat excessive facial flushing

ETS is usually performed after other treatment methods, such as taking anticholinergic medications to prevent sweat gland stimulation, have proven unsuccessful.

How Is an Endoscopic Thoracic Sympathectomy Performed?

Performing ETS requires special training. Be sure to select a surgeon who has been trained to perform this procedure.

Before the ETS procedure, you will be given general anesthesia. This will keep you asleep and pain-free during the procedure. The surgery usually takes between one and three hours.

Generally, during ETS your surgeon will:

  • make a small cut beneath your armpit
  • collapse your lung a little bit to provide more space for the surgery
  • insert an endoscope into your chest so that it can project an image of your nerves onto a monitor in the operating room
  • use precise instruments to cut or destroy the nerves that are causing excessive sweating
  • inflate your lung again
  • close the cut or cuts with stitches

A small tube may be left in the chest to help all the excess air escape from the chest cavity.

What Are the Risks Involved?

Risks of ETS include:

  • hemothorax (too much blood in the chest)
  • artery or nerve damage
  • compensatory sweating (increased sweating in other areas of the body, such as the back)
  • Horner syndrome (drooping eyelids and decreased facial sweating)

Risks of general anesthesia include an allergic reaction and breathing difficulties. General surgery risks include heart attack and stroke. All these complications are very rare.

Preparing for Endoscopic Thoracic Sympathectomy

Tell your health care provider if you could be pregnant, or if you are taking any medications, vitamins, or herbs—even over-the-counter ones.

Before the surgery, your health care provider may ask you to stop taking blood-thinning medications or vitamins, such as aspirin, ibuprofen, vitamin E, and warfarin. If you are a smoker, you should try not to smoke before the surgery.

Your doctor will give you detailed instructions about what to do the day of the surgery. You will probably be asked not to eat or drink anything the night before the ETS.

What Happens After an Endoscopic Thoracic Sympathectomy?

You may need to stay in the hospital overnight after your surgery. You may also experience pain for a week or so. Your health care provider may prescribe pain medication to help ease your discomfort.

After you return home, you should:

  • Keep your surgical area clean, dry, and dressed with bandages.
  • Wash the surgical area and change your bandages as often as your doctor recommends.
  • Avoid soaking in a bathtub or hot tub for two weeks.
  • Avoid swimming for two weeks.
  • Go for a follow-up visit so your doctor can see if the surgery was successful.

What Complications Are Associated With Endoscopic Thoracic Sympathectomy?

According to the Circulation Foundation (CF), about one in 100 patients will acquire severe compensatory sweating after surgery—excessive sweating somewhere else in the body. About one in 100 people may also develop Horner syndrome, in which one eyelid droops. Horner syndrome usually goes away, but not always (CF).

What Is the Outlook for Endoscopic Thoracic Sympathectomy?

ETS is a generally safe procedure that often successfully treats hyperhidrosis. According to the CF, ETS stops excessive hand sweating in 95 percent of cases. It stops excessive armpit sweating in 85 percent of cases. Over a 15-year time period, one study reported that 67 percent of patients surveyed were fully satisfied with the procedure (CF).

What Are Alternatives to Endoscopic Thoracic Sympathectomy?

Surgery to treat excessive sweating should only be done as a last resort, when other, less-invasive methods have failed. Before surgery, you may want to consider:

Antiperspirants

These are deodorants mixed with antiperspirant (anti-sweat) agents. They can stop or reduce sweating, but must be applied regularly in order to work. If antiperspirants irritate your skin, your health care provider may be able to prescribe you a steroid-based cream instead.

Botox injections

Botox is a protein and neurotoxin used for cosmetic and medical purposes. Botox can be injected into the site of the sweating, where it blocks the nerves. These injections may be quite unpleasant, however, when injected in the hands. The side effects for hand injections can include hand weakness and numbness. Therefore, Botox injections are considered more often to treat excessive armpit sweating. Injections in the armpit are generally more effective.

Iontophoresis

In this procedure, a machine passes electrical currents across the skin, helping to stop sweating. Numerous sessions are required to reduce your symptoms. The machine may also be purchased for home use.

Medication

Anticholinergic drugs, such as glycopyrrolate (Robinul, Robinul-Forte), can prevent the sweat glands from becoming stimulated, thereby stopping most sweating. These drugs can have unpleasant side effects, however, such as dry mouth, dizziness, and difficulty urinating.

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