Endoscopic thoracic sympathectomy (ETS) for Hyperhidrosis

Overview
Endoscopic thoracic sympathectomy (ETS) is a surgery used to treat severe hyperhidrosis when no other treatments are effective. ETS is most commonly considered in cases of severe palmar (hand) sweating, but may be considered for other types of sweating. ETS may be most successful in people younger than 25 whose hyperhidrosis began before age 16.

Due to significant and permanent side effects, ETS is rarely recommended.

Endoscopic means that the surgery is performed by inserting tiny cameras and tools through a small incision. Endoscopic surgery is considered minimally invasive. Thoracic refers to the section of the spine that runs through the middle back. The word sympathectomy means that some of the sympathetic nerves, which regulate body functions including sweating, will be cut or blocked.

What does it involve?
The goal of ETS is to interrupt the nerve signals sent from the thoracic spine to sweat glands.

ETS is performed under general anesthetic. During ETS, the surgeon will make two or three tiny incisions under the arm on the side where the excessive sweating occurs. The lung on that side will be temporarily deflated to allow the surgeon more space to work. The surgeon will insert a tiny camera and locate the sympathetic nerves of the thoracic spine that control sweating in the affected areas. They will then insert surgical tools and either cut or clip the nerves. The surgeon will then reflate the lung and close the incisions. If your other side is also affected by severe sweating, the surgeon may repeat the procedure on that side.

You may have a drainage tube for a day or two after ETS surgery.

Recovery
You can expect to remain in the hospital for one night after ETS. You may have pain for a week or two following surgery.

Results
ETS is believed to be effective in relieving palmar hyperhidrosis in 95 percent of people. People who have undergone ETS report an average rate of satisfaction ranging from 66.7 to 93 percent, but reported satisfaction rates often decline over time.

Constraints
ETS surgery is ineffective for hyperhidrosis in 1.2 percent of people.

Recurrent sweating may occur.

ETS surgery results in compensatory hyperhidrosis in 98 percent of those who undergo the procedure. This means that while the area targeted by the surgery may be significantly drier after ETS, other large areas of the body may become excessively sweaty to compensate. Areas most likely to begin sweating excessively after ETS include the abdomen, back, legs, and buttocks.

Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery. In rare cases, ETS surgery has resulted in pneumonia, blood or air collecting in the chest, Horner’s syndrome (drooping eyelids and other eye changes), unintended damage to arteries or nerves, slowed heartbeat requiring the implantation of a pacemaker, and at least one death.

There may be pain and inflammation during recovery from ETS.

ETS is irreversible.

For more details about this treatment, visit:

Endoscopic thoracic sympathectomy (ETS) – International Hyperhidrosis Society
https://www.sweathelp.org/hyperhidrosis-treatme...

Endoscopic thoracic sympathectomy – MedlinePlus
https://medlineplus.gov/ency/article/007291.htm