Endoscopic Thoracic Sympathectomy

Endoscopic thoracic sympathectomy or ETS surgery is a procedure that involves cutting nerves in the sympathetic chain in the chest. The operation is performed to treat excessive sweating or hyperhidrosis. It is a minimally invasive treatment of hyperhidrosis that is performed through incisions in the armpits. If you suffer from increased sweating and it is affecting your quality of life, keep reading to learn more about this operation and how it can help your condition.

What is hyperhidrosis?

Sweating is a normal phenomenon that allows us to regulate body temperature and keep the skin moist. Sweat is produced by tiny skin glands that are controlled by a part of the nervous system called the sympathetic nervous system. This system transmits nerve signals from the sweat glands. In some people, however, the nerve endings are dysfunctional and sweating occurs in excessive amounts or at inappropriate times.

Hyperhidrosis is a condition in which there is abnormal or excessive sweating, unrelated to heat or exercise. People with hyperhidrosis sweat to the extent that it soaks through clothes and drips off the palms, armpits, or other parts of the body.

Excessive sweating can cause many day-to-day challenges for people with hyperhidrosis, ranging from discomfort, anxiety, and embarrassment to personal and professional limitations depending on the problem area. For example, someone with increased sweating in the palms may not be able to hold a pen properly or perform certain activities safely.

There are many non-surgical and surgical treatment options for hyperhidrosis. Before considering surgical treatments, your doctor will recommend various non-surgical measures. However, if the hyperhidrosis continues to be a major and persistent problem, a surgical procedure may be recommended. Today, we're talking about one such option, an operation known as endoscopic thoracic sympathectomy or ETS surgery.

What is endoscopic thoracic sympathectomy?

Endoscopic thoracic sympathectomy ETS surgery is a minimally invasive procedure that is used to treat different types of hyperhidrosis, including axillary hyperhidrosis (excessive sweating in the armpits) and palmar hyperhidrosis (excessive sweating in the hands). It can also be used to treat facial sweating and flushing.

ETS surgery is an outpatient procedure which is performed through two keyhole incisions, one in each armpit. The surgeon uses a device called a thoracoscope to perform the surgery. The thoracoscope is a thin instrument with a tiny camera and light source that allows the surgeon to view the operation area. The procedure involves selecting and cutting specific sympathetic nerves in the chest. The disruption of these sympathetic nerves interrupts the signals from the sweat glands that travel via the sympathetic chain, thereby effectively treating the excessive sweating.

What the procedure does is it essentially turns off the sweat glands. This is a permanent solution for patients with palmar hyperhidrosis and axillary hyperhidrosis. However, it is a surgery and it does carry some risks of side effects and complications, like all surgeries.

What happens during thoracic sympathectomy endoscopic?

The ETS procedure is performed under general anesthesia. You will be asleep during the operation and will not experience any pain or discomfort. To perform the procedure, the surgeon makes a small incision in the armpit. The lung is collapsed slightly to make room for the surgeon to work. During this time, the lung on the other side remains intact and does the work of breathing.

The surgeon then inserts a thin telescopic camera into the chest and identifies the sympathetic nerve to be divided. One or two additional incisions may be needed to introduce the instruments to cut the sympathetic nerves, but this can usually be done through a single keyhole incision. After cutting the nerves, the surgeon re-expands the lung and removes the instruments. A small drain may be put in place for a few hours to allow any air in the chest cavity to escape.

Usually, an endoscopic thoracic sympathectomy is done on one side at a time. However, your surgeon may consider it appropriate to do both sides together. When the operation is done on one side, it is usually a day procedure. If you're having ETS surgery on both sides, it is likely you will have to stay overnight in the hospital.

Is ETS surgery safe?

In the hands of experienced surgeons, ETS surgery is a safe and effective procedure. The majority of patients do not experience any complications. However, as with any surgery, endoscopic thoracic sympathectomy does carry some risks, including the risk of injury in the chest, which may require a further operation. If bleeding occurs, it may be necessary to leave a drainage tube in place for a day or two to allow the fluid and blood to drain out. Rarely, ETS surgery can cause a complication known as Horner's syndrome, which is a droopy eyelid caused by a disruption of the sympathetic chain. This problem usually resolves, but can occasionally be permanent.

What are the side effects of endoscopic thoracic sympathectomy ETS surgery?

While ETS surgery is very effective in treating hyperhidrosis or increased sweating in the face, hands, and armpits, it causes a side effect of increased sweating elsewhere in the body. This phenomenon is called compensatory sweating. Compensatory sweating usually occurs in the chest and/or back. Some patients experience gustatory sweating when eating hot or spicy foods.

Most patients find that the compensatory sweating is much less of a problem than the original excessive sweating in the hands or armpits. Therefore, they consider ETS surgery a successful treatment of hyperhidrosis. Given this side effect, however, the procedure can be thought of as transferring sweating from one area of the body to another rather than making it disappear altogether.

Rarely, the compensatory sweating after an ETS surgery can be severe. It is, unfortunately, impossible to predict which patients will have major compensatory sweating as side effects. Given that the surgery is irreversible, this is a side effect of endoscopic thoracic sympathectomy that patients must keep in mind before going ahead with the procedure.

Is ETS surgery permanent?

The effects of endoscopic thoracic sympathectomy are permanent. The procedure is very effective in stopping excessive sweating with a 95% success rate in the hands and an 85% success rate in the armpits. Patients who have undergone this procedure in the past have been followed for more than a decade as part of clinical studies. It was found that more than 90% of patients report complete cure of their problem with endoscopic thoracic sympathectomy.

What are the alternatives to ETS surgery?

Endoscopic thoracic sympathectomy ETS is usually the last resort in people with hyperhidrosis. There are simpler solutions available, which if successful, do not carry the risks of a surgical procedure. Some of the non-surgical and surgical treatments besides ETS that can be used for excessive sweating include:

• Treatment with prescription-strength antiperspirants.
• Treatment with prescription creams and oral medications that reduce sweating.
• Botulinum toxin injections (Botox) to temporarily block the nerves in the affected area.
• Sweat gland removal from areas like the armpits.
• Microwave therapy to destroy sweat glands.
• Iontophoresis, which involves the use of electric current to reduce sweating.

People who suffer from excessive sweating can also try some lifestyle and home remedies to manage their symptoms. These include the liberal use of antiperspirants, wearing clothes made of natural materials, bathing daily to reduce skin bacteria and body odor, and changing socks and airing out the feet regularly. Relaxation techniques like yoga and biofeedback can help in those individuals in whom the excessive sweating is triggered by stress.

Is endoscopic thoracic sympathectomy right for me?

If you are troubled by excessive sweating and it is affecting your quality of life, there are various treatment options available to you. You should first try simple measures like antiperspirants or iontophoresis (the machine can be used at home). If these non-invasive, non-surgical measures fail, and the excessive sweating is having a severe impact on your life, it may be time to consider a sympathectomy endoscopic thoracic approach. ETS is particularly recommended if the sweating involves your hands, since success rates are high in this problem area. For facial sweating or armpit sweating, your doctor may recommend less invasive options like Botox injections.

In short, it is sensible to consider endoscopic thoracic sympathectomy if sweating is a major problem, your hands are affected, and other treatments have not worked.

How much does endoscopic thoracic sympathectomy cost?

Hyperhidrosis or excessive sweating is a medical diagnosis that can have serious physical and psychological effects without treatment.

Endoscopic thoracic sympathectomy is not a cosmetic procedure. ETS surgery is, therefore, usually covered by health insurance because it is considered a medical necessity. Nonetheless, if you are paying out of pocket, the average cost of this surgical treatment for hyperhidrosis is roughly $10,000.

Finding a provider for ETS surgery

The MeTime app makes it easy to find surgeons for ETS surgery near you. If you suffer from hyperhidrosis, you can click and upload pictures and have suggestions sent directly to you. To learn more about your treatment options and book a consultation for potential endoscopic thoracic sympathectomy, try the MeTime app today!