What is Endoscopic Thoracic Sympathectomy?

H. Colledge

An endoscopic thoracic sympathectomy, or ETS, is a type of surgery performed to treat a condition known as hyperhidrosis, where sufferers sweat excessively. Sometimes the operation may be carried out to treat facial blushing, if this has become a serious problem that interferes with a person's everyday life. What are called sympathetic nerves pass through the chest, or thorax, on their way to supply the glands that produce sweat in the palms and the armpits. During an endoscopic thoracic sympathectomy, these sympathetic nerves are cut, and the sweat glands no longer function. Possible drawbacks of the procedure include increased sweating in other parts of the body, which may be extreme in rare cases.

ETS may be done to treat facial blushing.
ETS may be done to treat facial blushing.

Hyperhidrosis can begin at any age and may be confined to certain areas or involve the whole body. It can arise by itself, or be associated with other illnesses such as hormone disorders, infections, cancer or alcoholism. Sometimes, treating an underlying disease helps to improve the condition, or the sweating may be controlled using antiperspirants or drugs known as anticholinergics. If these measures fail, injections of Botulinum toxin can sometimes be used to block the nerves that control sweating, or a procedure called iontophoresis may be effective, which sends electric currents across the skin. Finally, surgical procedures such as endoscopic thoracic sympathectomy may be considered.

Sympathetic nerves supply the glands that produce sweat in the armpits.
Sympathetic nerves supply the glands that produce sweat in the armpits.

An endoscopic thoracic sympathectomy is a type of keyhole surgery. The operation is carried out using a specially designed viewing telescope and tiny surgical instruments that can be inserted through small cuts in the skin, removing the need to make a large incision. Advantages of the endoscopic technique include shorter operating times, decreased scarring, and fewer complications.

An endoscopic thoracic sympathectomy is a surgical procedure that intends to treat excessive sweat.
An endoscopic thoracic sympathectomy is a surgical procedure that intends to treat excessive sweat.

During the endoscopic thoracic sympathectomy, one of the lungs is collapsed temporarily to allow more room to carry out the procedure. The viewing instrument is inserted through a small cut below the armpit and passed into the chest to show images of the nerves to be operated on. Images from the operation site can be seen on a monitor while the surgeon is at work. Surgical instruments are introduced through another small hole and the sympathetic nerves are cut. Following the operation, the lung is reinflated.

Although most people experience a successful outcome following endoscopic thoracic sympathectomy, there are a number of possible complications. Occasionally a problem known as compensatory hyperhidrosis develops, where excessive sweating begins to occur in a different area of the body. Most often this affects the skin of the back or the chest. As the endoscopic thoracic sympathectomy procedure cannot be reversed, it can be important to be aware of the possibility of this rare complication occurring.

Alcohol abuse can cause hyperhidrosis.
Alcohol abuse can cause hyperhidrosis.

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