What is an ETS Surgery?

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  • Written By: Andy Josiah
  • Edited By: Nancy Fann-Im
  • Last Modified Date: 27 February 2020
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ETS surgery is a shortened term for endoscopic thoracic sympathectomy, a surgical procedure used to control or reduce excessive sweating. The medical term for such a condition is hyperhidrosis. Although ETS surgery is the most common form of hyperhidrosis treatment, its controversial nature has prevented it from achieving greater popularity.

Endoscopic thoracic sympathectomy is named after the part of the body that it focuses on. Surgeons destroy a significant amount of tissue or nerve fibers at the sympathetic nervous system (SNS), or the sympathetic chain of the autonomous nervous system (ANS), which generates the sweating. The SNS extends from the neck to the lower back. ETS surgery, however, focuses specifically on the upper thoracic or chest section. This consists of the area between the first thoracic vertebrae signifying the bottom of the body's neck to the fifth one marking the top of its spine.

Although ETS surgery is most commonly used to treat hyperhidrosis, it is also applied to other medical conditions. Surgeons use the procedure to cure Raynaud's phenomenon, a discoloration of areas of the body like the fingers and toes due to decreased blood supply. A third affliction that ETS surgery treats is long QT syndrome, a heart disorder characterized by irregular rhythms. Physicians can also treat facial blushing or headaches with the hyperhidrosis treatment.


The origin of ETS surgery can be traced back to the mid-1800s, when physicians began to learn of the link between the ANS and certain bodily functions. Eventually, they developed an invasive procedure that involves making two holes at each side of the chest area, the neck or the back. One hole is for introducing the titanium clamps to disable the nerve fibers, and the other one is for slipping in a video camera to monitor the activity.

ETS surgery is not without its drawbacks. Since the procedure involves an alteration of part of the ANS, it can adversely affect other bodily functions, including body temperature, heart rate, stroke volume, exercise capability and alertness. In extreme cases, the surgery has disabled patients. Sweden, one of the earliest places to practice ETS surgery, banned it in 2003. Taiwan forbade the treatment on patients younger than 20 years of age the following year.

Despite its shortcomings, ETS surgery remains the world's only significant treatment for excessive sweating. Over the years, the period of recovery from the surgery has been reduced and the method of incision refined. Regarding the latter factor, the holes are as tiny as the diameter of a small drinking straw.


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