Endoscopic Thoracic Sympathectomy

Endoscopic thoracic sympathectomy (ETS) is used mainly as a treatment for excessive sweating (hyperhidrosis) but can also be used to help treat extreme facial flushing.  Sweat is produced by thousands of little glands in the skin which are controlled by our sympathetic nervous system.

An ETS involves cutting these sympathetic nerves which switches off the sweating. The sympathetic nerves that control the sweat glands of the hand and armpits runs inside the rib cage near the top of the chest. The development of surgical telescopes and cameras has led to the ability to divide these nerves through very small incisions, which can improve symptoms.

The operation
This operation is performed under general anaesthetic. A small incision is made beneath the armpit. The lung, on the side being operated on, is allowed to collapse a little to help make room for the operation. Your other lung remains intact and is capable of doing all the work. A camera on a thin telescope is put into the chest, and the nerves which are to be divided are found. One other small hole may be made to put in the instruments that divide the nerves, although this can also be done using the same hole as for the camera. After the nerves have been cut, the lung is re-expanded and the instruments removed. Sometimes a small drain (plastic tube) is left in the chest for a few hours to make sure all the air is removed from the chest cavity.

Your surgeon will discuss with you if it is advisable to do both sides at once. The operation may be done as a day surgery, or with an overnight stay if you need surgery on both sides.

How successful is it?
ETS is very effective at stopping sweating of the hands in over 95% of cases; it is slightly less effective at stopping sweating in the armpits (about 85%). Over time sweating will recur in a few people. In a study following patients over a 15 year period:

93 % reported complete cure of sweating
67% were fully satisfied
27% were partially satisfied and would have the operation again
7% said they would not have the operation again

*From The Circulation Foundation