Endoscopic thoracic sympathectomy (ETS) is a procedure most commonly performed to treat excessive sweating in a body part like your hands or armpits.

During ETS, a surgeon cuts the trunk of a nerve that runs from your spine to your sweat glands.

The name of this procedure can be broken into three parts:

  • “Endoscopic” means that a surgeon performs the procedure with a long, thin tube called an endoscope that allows for smaller incisions than traditional surgery.
  • “Thoracic” means that a surgeon performs the procedure on nerves in your mid-spine.
  • “Sympathectomy” is a procedure where a surgeon destroys a section of a nerve in your sympathetic nervous system.

Read on to learn more about ETS, including what it treats and how surgeons perform the procedure.

Surgeons most commonly perform ETS to treat local hyperhidrosis, which is excessive sweating in a certain body part. The most common places for this condition include the:

  • hands
  • feet
  • armpits

Your doctor may recommend ETS to treat local hyperhidrosis if conservative treatment options don’t work.

The procedure can also treat conditions like:

Compensatory sweating is a common side effect of ETS. It’s the overproduction of sweat in body parts other than the area treated. It often occurs around your:

  • back
  • chest
  • abdomen

In a 2023 study, researchers found that compensatory sweating occurred in 89.8% of 49 people who had surgical treatment for hyperhidrosis in Cuba. Some studies have reported compensatory sweating ranging from mild to severe in up to 98% of people.

Other potential side effects include:

According to a 2021 paper, studies have reported success rates for treating facial, hand, or armpit sweating between 68% and 100%, with an immediate satisfaction rate reaching 100%.

In the study from Cuba, 95.9% of people reported a significant improvement in their quality of life at a follow-up at least 30 days after their procedure.

In the 2021 paper, researchers reported a satisfaction rate of 92% and a symptom control rate of 96% among over 1,400 people who received a variation of the procedure called video-assisted thoracoscopic sympathectomy.

The ideal candidates for ETS have previously tried but haven’t responded to conservative treatments to reduce sweating, such as stress reduction or antiperspirants.

Some people may not be eligible for ETS. These include:

  • people with lung or heart disease
  • people with poor overall health
  • older adults

Learn more about reducing sweating.

Here’s a general idea of what to expect during ETS.

Before ETS

Before your procedure, your surgeon will tell you what to expect during your surgery and answer any questions you have.

You may also receive tests to check your fitness, such as:

During ETS

Your procedure will likely look something like this:

  1. You’ll receive a general anesthetic through an IV line connected to a vein in your arm or hand.
  2. Once you’re asleep, your surgeon will make one or two incisions on the side of your chest, under your armpit. They usually make these incisions between your second and sixth rib.
  3. Your surgeon will slightly collapse your lung on the same side as your incisions so that they have space to complete the procedure.
  4. They’ll insert a thin tube with a light and camera called an endoscope, along with other special tools, into your body through one of the incisions.
  5. Your surgeon will use these tools to destroy the trunk of the nerve that tells your sweat glands to produce sweat.
  6. They’ll then close your wounds with stitches and cover them in bandages.

After ETS

You may have one or two tubes in your incisions when you wake up to help drain your wounds. It’s normal to feel sore when you breathe in deeply or cough.

Most people spend about a day in the hospital.

You’ll need to stop eating about 6 hours and stop drinking about 2 hours before your surgery.

You may need to stop taking blood-thinning medications like warfarin before your procedure. Also, surgeons often advise quitting smoking before surgery to improve your healing.

Most people have soreness in their chest after their procedure. The pain usually improves after several days but may last a couple of weeks.

It’s a good idea to avoid strenuous activity after your procedure for 3 or 4 weeks or until your doctor says it’s OK to restart.

Most people can return to work after about a week or two.

Alternative treatments for excessive sweating include:

  • making lifestyle changes, like:
    • drying your skin frequently
    • managing emotional stress
    • losing weight, if needed
  • using antiperspirants
  • trying iontophoresis
  • getting Botox injections
  • taking anticholinergic drugs, like Qbrexza

Here are some frequently asked questions that people have about ETS.

How much does endoscopic thoracic sympathectomy cost?

The cost of ETS varies based on factors like where you live. For reference, the nonprofit FAIR Health estimates that 80% of procedures in Jacksonville, Florida, are under $2,647 without insurance. Hospital costs and anesthetics can add another $12,000 or more.

Do your hands still sweat after ETS surgery?

Most people have satisfactory sweating improvement after their surgery. However, it’s common to develop new or increased sweating in other parts of your body.

Why is ETS banned in Sweden?

According to the International Hyperhidrosis Society, although ETS was first performed in Sweden, it’s now banned due to concerns over its risks.

ETS is a procedure that involves cutting the trunk of a sympathetic nerve that signals for your skin to produce sweat. Most people have improvements in their sweating symptoms following ETS, but it’s common to develop sweating in other parts of your body.

Your doctor will likely suggest other treatments, like antiperspirants or Botox injections, before trying surgery. ETS is usually reserved for people whose condition doesn’t respond to conservative treatments.