ETS – Endoscopic Thoracic Sympathectomy

In this procedure, the doctor creates an incision to access the sympathetic chain that runs along the lumbar vertebrae.

The operation is done under general anesthesia and takes about 1 to 2 hours.

Normal Recovery:

1. Patients go home the same day
2. Patients return to work/school within 2-3 days
3. Patients traveling from out of town can fly home the following day after surgery
4. Exercising and working out – after one week

(Above are normal recovery expectations. You should always follow your surgeons’ specific instructions)

The operation is done endoscopically. In this approach there are three small incisions made on the side of the abdomen (flank region). The largest cut is about 15mm or 1.5cm, and the other two on each side are about 5-7mm. Through these cuts, endoscopic equipment is inserted. A space behind the abdomen is developed which then allows the sympathetic chain running along the lumbar vertebrae to be located.

The sympathetic chain is then clamped at the T3 to T4 segment of the sympathetic nerve node responsible for the cause of excessive sweating. Four titanium clips are placed on each side of the nerve chain. In cases of severe armpit sweating along with excessive hand sweating, clips are applied on the T5 level. The total amount of clips can range from 4 to 6. It is important to place the clamps at the precise level to reduce the possibility of side effects. The exact location is confirmed with the help of X-Rays during the operation

At the present time, clamping is the procedure of choice by our surgeons. The primary reason for using this clamping procedure, is that it leaves the possibility for easy reversal if needed. If a patient is unhappy with the results of the procedure, a reversal may be done by performing a nerve graft operation. This procedure is much more involved, and time consuming when compared to clamp removal. In the clamping method, reversal is much easier because it simply requires removal of the clips, and by doing so gives the nerve segment the ability to regenerate. It has been shown that some patients who had the clamps removed showed less compensatory sweating (compensatory hydrosis or reflex sweating), or a total recovery from their previous symptoms.

Make sure before any decisions are made to discuss the particulars of this operations with an experienced hyperhidrosis surgeon, including risks involved. To ask questions and learn more about how this life changing procedure could possibly help you, please contact us.

Patients who have a similar problem with sweating in the hands and armpit area will benefit from the endoscopic thoracic sympathectomy on levels T3, T4, and T5. In other words, for those patients who describe their excessive hand sweating as equal to their excessive armpit sweating, adding sympathectomy at the T5 level will give them a higher chance of minimizing or eliminating their armpit problem as well. On the other hand, if patients only have excessive armpit sweating, it is our surgeon’s current opinion is that a sympathectomy should not be done for isolated armpit sweating.

There is tremendous overlap in function within the sympathetic chain, so there are no known long-term side effects. As the name implies, this is a chain of ganglia and not just one nerve.

No, our surgeons use the single lumen intubation method. This always allows air to go in and out of the lungs . Surgeons that are using the double lumen technique collapse the lung on the side they where they are operating.

Our surgeons have performed dozens of clamp removal procedures. The results vary but about 50% of those cases showed improvements in their clinical condition. This translated into a reduction of compensatory sweating, better exercise tolerance, re-appearance of sweat in the hands and upper body, etc. Obviously more time is needed to come to any definite conclusions, but even in these scenarios, the results are promising

Most patients are able to walk out of the medical center within 2 hours after surgery. Regular physical activity and returning to work are both possible in one week or less. Scarring is minimal (About 10mm or 1cm), as the incisions are small and well hidden in the folds of skin.

The doctors personally check up with each patient post-surgery to ensure they are perfectly taken care of, and to answer any and all their questions. We take pride in his excellent patient care. This is very evident in any of the patient testimonials we have received.

In numerous studies, as well as in our experience, the patient’s quality of life is improved dramatically after the operation. For most people, after living under the cloud of hyperhidrosis for so long, the ability to appear with confidence in public and social settings is amazing. This coupled with an improvement on simple daily tasks such as driving, computer usage, writing, and personal interactions is very uplifting.

For examples please see any number of our numerous hyperhidrosis success stories.

Sweaty palms are corrected in over 98% of cases with the ETS procedure.

To learn more about how this life changing procedure could possibly help you, please CONTACT US.

As with all surgery, there are possible risks and side effects. Be sure to ask your surgeon about risks and side effects prior to surgery, and please read below the information below.

With ETS, there are several possible side effects. Compensatory sweating (compensatory hydrosis or reflex sweating) is the most bothersome. Compensatory sweating is described as excessive sweating on the back, abdomen, thighs, and/or lower legs. This should be expected to a certain degree in all patients, and it ranges from mild to severe.

Most patients will develop mild to moderate compensatory sweating which is preferable to the sweaty hands they had prior to the surgery. This means that patients who previously had the ETS procedure for reasons unrelated to sweating will have compensatory sweating as well. This demonstrates that compensatory sweating is a by-product of the operation and not necessarily of the hyperhidrosis condition itself.

Since compensatory sweating is the most common side effect, more should be known about it and what is being done to improve this side effect. Over the last several years, the clamping method procedure has created an improvement regarding the possibility of reversal.

Recently, lowering the level of the clamps to the third and fourth ganglia has had some positive effects on compensatory sweating. This portion of the site will be updated as more information is discovered. Our surgeons are very involved in making sure these types of issues are relayed to the public in order to benefit everyone.

A much smaller group of 3% – 5% will experience more severe compensatory sweating. Severe compensatory sweating can affect the satisfaction of patients who had the procedure done. Severe compensatory sweating can be very troublesome, especially when it soaks through clothing. It is a difficult situation, especially in hot humid summer days.

So far, attempts to find a common thread among those patients who develop severe compensatory sweating has not yet yielded any concrete answers. However, most patients who develop mild to moderate compensatory sweating say that they are not troubled by this extra perspiration. For them, it is preferable to sweaty palms.

On the other hand, those patients who develop severe compensatory sweating will complain about this excessive extra sweating. This is especially true in hot, humid weather, or certain anxious situations. It is important to note that compensatory sweating could be a side effect for anyone receiving ETS, regardless of whether they had hyperhidrosis or not prior to the surgery.

No operation is without risk. Complications are not common for this surgery, but they may include the following: excessive bleeding, infection, and injury to surrounding organs. Pneumothorax, a condition in which air remains in the chest wall, can also develop – although it is both rare and treatable.

Side effects, such as fatigue, hair loss, loss of concentration, scalp itchiness, weight gain, shortness of breath, and reduction of exercise ability were all mentioned in an anecdotal fashion by different patients. These effects did not appear in most patients.

Not every side effect could be directly related to the sympathectomy, but overall these kinds of side effects have been noted by patients in the past. Any questions should be directed to the surgeon before making any decision about the operation.

A short time after the operation, 3-1/2 to 4 days, some patients will have a temporary recurrence of sweating on their palms. This is a short-lived phenomenon that might last for half a day. This is a short-lived phenomenon that might last for half a day. In contrast to this short-lived recurrence is the possibility of a partial or full recurrence of sweaty hands and feet.

This is always a possibility, but only occurs in a very small percentage of cases. In different studies it has been shown that a 1-2% recurrence rate does exist, but it should be emphasized that there is no difference between the method used to do the sympathectomy. The excisional method, chemical, the burning method, or the clamping method have the same recurrence rates. For much more in depth information on this please see our hyperhidrosis recurrence page.

This question is sometimes posed by previous patients and potential patients alike. Unfortunately, the exact physiological and anatomical explanation is not yet known. Hopefully with time more studies will shed light on the problem.

Potential patients who are overweight should be aware that they might get compensatory sweating somewhat easier than a person of normal weight. Patients who already have signs of excessive sweating on other parts of the body (abdomen, back, thighs), besides the hands, should be aware that they might develop more compensatory sweating than others.

Gustatory sweating is another side effect which occurs in about 5% of cases. This condition, in which patients notice that they tend to experience increased sweating while eating or smelling certain foods, develops in rare instances. Please discuss side effects thoroughly with your surgeon.

“Horner Syndrome” (also known as droopy eye syndrome) is also a complication associated with the surgery. This particular and uncommon condition can occur in 0.1% of cases. Dr. Reisfeld has never had a Horner Syndrome case in all his years of practice (21+ years). In these rare instances, patients have experienced drooping of the upper eyelids, constriction of the pupils, and dryness of the eyes.

Horner Syndrome has not been reported by any of our patients, but all the above problems can be adequately treated if they occur.

Reduction in heart rate is reported in a very small number of cases as well, and usually does not have physiological significance. On the other hand, some athletes engaged in heavy physical activity, such as marathon runners and tri-athletes, report that they could not reach their maximum heart rate after the procedure. The exact physiological significance of this side effect has not yet been determined by cardiac physiologists. Because of the significant influence of the autonomic nervous system on cardiovascular function, the effect of T2 denervation on the autonomic control of cardiac function has been investigated.