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Endoscopic thoracic sympathectomy

Endoscopic thoracic sympathectomy (ETS) is surgery to treat sweating that is much heavier than normal. This condition is called hyperhidrosis . Usually the surgery is used to treat sweating in the palms or face. The sympathetic nerves control sweating. The surgery cuts these nerves to the part of the body that sweats too much.

You will receive general anesthesia before surgery. This will make you asleep and pain-free.

Your surgeon will make 2 or 3 tiny surgical cuts under each arm.

  • Your lung on this side will be deflated (collapsed) so that air will not move in and out of it during surgery. This gives your surgeon more room to work.
  • A tiny camera called an endoscope will be inserted into your chest. Video from the camera will show on a monitor in the operating room. The surgeon will use the monitor to do your surgery.
  • The surgeon will insert other small tools through the other cuts.
  • Using these tools, your surgeon will find the nerves that control sweating in the problem area. These will be cut or destroyed.
  • Your lung on this side will be inflated.
  • The surgeon will close your cuts with sutures (stitches).
  • A small drainage tube may be left in your chest for 1 day

After doing this procedure on one side of your body, the surgeon will do the same thing on the other side. The surgery takes about 1 to 3 hours.

Alternative Names

Sympathectomy - endoscopic thoracic; ETC

Why the Procedure Is Performed

This surgery is usually done in patients whose palms sweat much more heavily than normal. It may also be used to treat extreme sweating of the face. It is only used when other treatments to reduce sweating have not worked.

Risks

Risks of anesthesia are:

Risks of surgery are:

Risks of this procedure are:

  • Blood collection in the chest (hemothorax )
  • Air collection in the chest (pneumothorax )
  • Damage to arteries or nerves
  • Horner syndrome (decreased facial sweating and drooping eyelids)
  • Increased or new sweating
  • Increased sweating in other areas of the body (compensatory sweating)
  • Slowing of the heart beat

Surgeons who perform ETS must receive special training. Before having this surgery, make sure your surgeon has this training.

Before the Procedure

Tell your doctor or nurse:

  • If you are or could be pregnant
  • What drugs, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription

During the days before the surgery:

  • You may be asked to stop taking medicines that make it hard for your blood to clot. Some of these are aspirin, ibuprofen (Advil, Motrin), and warfarin (Coumadin).
  • Ask your doctor which medicines you should still take on the day of your surgery.
  • If you smoke, try to stop. Ask your doctor or nurse for help quitting.

On the day of your surgery:

  • You will usually be asked not to drink or eat anything after the midnight before surgery.
  • Take the medicines your doctor told you to take with a small sip of water.
  • Arrive at the hospital on time.

After the Procedure

Most people stay in the hospital 1 night and go home the next day. You may have pain for about a week. Take pain medicine as your doctor recommended. You may need acetaminophen (Tylenol) or prescription pain medicine. Do not drive if you are taking narcotic pain medicine.

Keep your surgical cut areas clean, dry, and covered with dressings (bandages). Wash the areas and change the dressings as your doctor told you to do. Do not soak in a bathtub or hot tub, or go swimming for about 2 weeks.

Slowly resume your regular activities as you are able.

Your doctor will ask you to schedule a follow-up visit to inspect your incisions and to see if the surgery was successful.

Outlook (Prognosis)

This surgery improves the quality of life for most patients. It does not work as well for people who have very heavy armpit sweating. Some people may notice new sweating, but this may go away on its own.

References

Boley TM, Belangee KN, Markwell S, Hazelrigg SR. The effect of thoracoscopic sympathectomy on quality of life and symptom management of hyperhidrosis. J Am Coll Surg. 2007;3:435-438.

Krasna, MJ. Thoracoscopic sympathetectomy. Thorac Surg Clin. 2010;20;323-330.

Updated: 2/1/2013

Joshua Kunin, MD, Consulting Colorectal Surgeon, Zichron Yaakov, Israel. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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