Endoscopic thoracic sympathectomy
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 sympathetic nerves control sweating. The surgery cuts these nerves to the part of the body that sweats too much.
Sympathectomy -- endoscopic thoracic; ETC
You will receive general anesthesia before surgery. This will make you asleep and pain-free.
The surgery is usually done the following way:
- The surgeon makes 2 or 3 tiny cuts (incisions) under one arm.
- Your lung on this side is deflated (collapsed) so that air does not move in and out of it during surgery. This gives the surgeon more room to work.
- A tiny camera called an endoscope is inserted through one of the cuts into your chest. Video from the camera shows on a monitor in the operating room. The surgeon views the monitor while doing your surgery.
- Other small tools are inserted through the other cuts.
- Using these tools, the surgeon finds the nerves that control sweating in the problem area. These are cut, clipped, or destroyed.
- Your lung on this side is inflated.
- The cuts are closed with stitches (sutures).
- A small drainage tube may be left in your chest for a day or so.
After doing this procedure on one side of your body, the surgeon will do the same thing on the other side. The surgery takes about 1 to 3 hours.
Why the Procedure is Performed
This surgery is usually done in people 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 to reduce sweating have not worked.
Risks of anesthesia and surgery in general are:
Risks of this procedure are:
- Blood collection in the chest (hemothorax)
- Air collection in the chest (pneumothorax)
- Damage to arteries or nerves
- Horner syndrome (decreased facial sweating and drooping eyelids)
- Increased or new sweating
- Increased sweating in other areas of the body (compensatory sweating)
- Slowing of the heart beat
Before the Procedure
Tell your surgeon or health care provider:
- If you are or could be pregnant
- What medicines, 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 medicines that make it hard for your blood to clot. Some of these are aspirin, ibuprofen (Advil, Motrin), and warfarin (Coumadin).
- Ask your surgeon which medicines you should still take on the day of your surgery.
- If you smoke, try to stop. Ask your provider for help quitting. Smoking increases the risk for problems such as slow healing.
On the day of your surgery:
- Follow instructions about when to stop eating and drinking.
- Take the medicines your surgeon told you to take with a small sip of water.
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 or two. Take pain medicine as your doctor recommended. You may need acetaminophen (Tylenol) or prescription pain medicine. DO NOT drive if you are taking narcotic pain medicine.
Follow the surgeon's instructions about taking care of the incisions, including:
- Keeping the incision areas clean, dry, and covered with dressings (bandages).
- Wash the areas and change the dressings as instructed.
- 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.
Keep follow-up visits with the surgeon. At these visits, the surgeon will check the incisions and see if the surgery was successful.
This surgery improves the quality of life for most people. 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.
Kim BS, Bookland M, Hallo JI. Endoscopic thoracic sympathectomy. In: Jandial R, McCormick PC, Black PM, eds. Core Techniques in Operative Neurosurgery. Philadelphia, PA: Elsevier Saunders; 2011:chap 91.
Langtry JAA. Hyperhidrosis. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 105.
Reviewed By: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.