Endoscopic Thoracic Sympathectomy (ETS)

People who suffer from excessive sweating in the hands, face or armpits have the option of undergoing an ‘Endoscopic Thoracic Sympathectomy’ (ETS). This operation involves a small incision into the body cavity, in order to sever or clamp part of the thoracic sympathetic chain on the central nervous system. People who suffer from hyperhidrosis have been shown to have pathologically overactive sympathetic nerves, which control the sweat glands and trigger sweating far beyond physiological need. Therefore the ETS procedure impedes this nervous response and can significantly reduce, and in some cases cure, excessive sweating.

A sympathectomy is performed with tiny, endoscopic equipment, and so there is minimum trauma to the surrounding muscle and tissue structures. It can be performed through an outpatient clinic under general anaesthetic, and usually takes just an hour to perform. Most patients should be able to go home that day, and return to their jobs within a week.

There is a great deal of overlap in function within the sympathetic chain, and some people can experience some side effects to the procedure, such as Horner’s Syndrome, which can result from facial hyperhidrosis procedures. Horner’s Syndrome affects the nerves in the face and can cause drooping eyelids, constricted pupils or dry eyes. For palmer hyperhidrosis there can be a risk of weakness in the hands following the ETS procedure. Also some people experience compensatory sweating in other parts of the body, such as the thighs, abdomen, or back. Because of these possible side effects, some people choose to have their ETS carried out with the clamping, rather than severing method, as this can make it possible to do a reversal procedure if patients experience any significant problems. Clamping is carried out with titanium clips, which are safe for both long and short term implantations and do not interfere with medical equipment such as MRI scans or x-rays.

ETS can be performed on people from the age of 10 years through to around 66 years old, but generally it is recommended for younger people to wait until at puberty has passed, and their bodies have developed more physically and mentally. Therefore the minimum age for this procedure is normally 16 years old. People who suffer from some illnesses such as cardio-respiratory or thyroid diseases may not be eligible to undergo this type of surgical procedure.

The success rates of ETS procedures are good, averaging at around 98% for palmar hyperhidrosis (hand sweating). It is not recommended that ETS be carried out for plantar hyperhidrosis, as the success rate is very low at only 30%, and there is a significant risk of impairing sexual function. New surgical treatments for plantar hyperhidrosis are available, such as a lumbar sympathectomy, but although this has been shown to have a 90-95% success rate it is a much longer and more demanding procedure.

As with any operation there can be a risk of recurrences. With the ETS procedure the nerve can sometimes re-grow, or new pathways can emergence that bypass the interference, allowing hyperhidrosis to reoccur. This is not very common, and surgeons can in some cases perform a follow up procedure to correct this, or recommend another form of treatment.