Micro-Invasive Endoscopic Sympathectomy

Endoscopic sympathectomy is a surgery on your nerves that is less invasive than a standard surgical sympathectomy procedure. It treats health issues caused by overactive sweat glands.

Special nerve fibers along the spinal cord, known as the sympathetic chain, activate these sweat glands. The surgery stops nerve signals from the spine from turning on your sweat glands.

UPMC surgeons use the safest, most minimally invasive techniques available to restore comfort, confidence, and quality of life for people with overactive sweat glands — even when other treatments have not helped.

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What Is an Endoscopic Sympathectomy?

An endoscopic sympathectomy is a spinal surgery on your nerves. It uses less invasive techniques than traditional approaches and has a quicker and more comfortable recovery. During the procedure, your doctor operates on a bundle of nerves along the side of your spinal cord called the sympathetic chain.

The surgery uses an endoscope — a tube that lets your doctor operate through one or two small cuts instead of a large opening. The endoscope has a video camera and a light that allows your doctor to see the surgical area. Your surgeon will also use small surgical instruments to perform the procedure.

Types of endoscopic sympathectomy procedures

Endoscopic sympathectomy can be used to treat all three regions of the sympathetic nerve trunk:

• Cervical (neck area).
• Lumbar (lower back area).
• Thoracic (chest area).

The most common form of this procedure is endoscopic thoracic sympathectomy (ETS) surgery. 

Conditions we treat with an endoscopic sympathectomy

An endoscopic sympathectomy can treat health issues caused by overactive sweat glands, including:

• Blood flow problems caused by Raynaud's disease.
• Facial blushing.
• Hyperhidrosis (excessive sweating).
• Reflex sympathetic dystrophy (a type of complex regional pain syndrome).
• Social phobia.

This technique also treats other health issues caused by damage to these nerves.

Why Would I Need an Endoscopic Sympathectomy?

An endoscopic sympathectomy is for people with excessive sweating or other health issues related to the sympathetic chain.

Who is a candidate for endoscopic sympathectomy?

The ideal candidate for endoscopic sympathectomy is anyone who sweats so much that they are uncomfortable to the point where it limits the activities they can enjoy. People who experience excessive sweating after trying all other treatments may also be candidates. 

Alternatives to an endoscopic sympathectomy

Alternatives to an endoscopic sympathectomy include:

• Nonsurgical treatments to manage symptoms.
• Traditional open sympathectomy.

What Are the Risks and Complications of an Endoscopic Sympathectomy?

As with any medical procedure, an endoscopic sympathectomy has some risks.

Possible complications include:

• Blood clots.
• Infection or bleeding at the incision site.
• Problems with anesthesia.

What are the side effects of an Endoscopic sympathectomy?

In addition to general surgical complications, side effects may include:

• Compensatory sweating — Sweating in a new area of your body.
• Hemothorax — When blood collects in your chest.
• Horner syndrome — Causes droopy eyelids and decreased facial sweating. (This complication is rare.)
• Pneumothorax — When air collects in your chest.

What Should I Expect From an Endoscopic Sympathectomy?

Before: How to prepare for an endoscopic sympathectomy

Before your procedure, you will meet with your care team and have a physical exam.

Your care team may order tests, such as:

• Blood or urine tests — Ensures you are healthy enough for the procedure and to check for signs of illness or infection.
• Electrocardiogram (ECG or EKG) — Records the electrical activity of your heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage. EKGs are often performed before a procedure to make sure your heart is healthy and identify potential problems.
• MRI— To produce detailed images of organs and structures within your body.
• X-ray — To learn more about the condition of the bones and tissues in your spine.

Your doctor will explain the procedure to you and answer your questions. To prepare for the procedure, you should:

• Fast for a certain period of time prior to the procedure. Your doctor will tell you if you need to fast or how long to fast (usually overnight).
• Have any tests your doctor recommends. For example, your doctor may request a blood test before the procedure to determine how long it takes your blood to clot.
• Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
• Tell your doctor if you have any other health conditions. Your care team may need to take certain precautions during your procedure for your safety.
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. You may need to stop some medications prior to the procedure.

On the day of your procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables like cash and jewelry at home.

Endoscopic sympathectomy is usually an outpatient procedure, so you will be discharged on the same day. You will need to arrange for someone to drive you home after you are discharged.

How long does an endoscopic sympathectomy take?

An endoscopic sympathectomy usually takes one to two hours.

During your endoscopic sympathectomy

When you arrive at the hospital, you will meet with your care team for final preparations.

You will receive an IV and general anesthesia, which means you will be asleep during the procedure and will not feel any pain.

You will be positioned on a procedure table on your stomach. Your doctor will:

• Make one or two small cuts in your back.
• Insert the endoscope, which allows them to see the surgical area, and small surgical instruments to perform the procedure.
• Clamp your nerves with surgical instruments. Nerves are clamped instead of removed, so you can reverse the procedure if you experience rare or uncomfortable side effects.

After your procedure, your surgeon will close your incisions and make sure your condition is stable.

How painful is an endoscopic sympathectomy?

You will be asleep during the procedure and will not feel any pain. After the procedure, you may feel sore and have bruising around your incision site.

How safe is an endoscopic sympathectomy?

Endoscopic sympathectomy is a safe procedure. Because the procedure is minimally invasive, it involves smaller incisions than traditional procedures and reduces your risk of complications, blood loss, and pain.

Recovery after endoscopic sympathectomy

After your procedure is complete, you will be monitored in the recovery area. You may feel sore around your incision site.

Most people leave the hospital within a few hours of surgery. Your doctor will let you know when it is safe to go home.

Before you go home, your doctor will tell you:

• How to care for your wound and watch for signs of infection or complications.
• What medications you need to take.
• When to call your doctor or 911 if you have certain symptoms.
• When you can return to your normal activities, such as driving and bathing.

Most people can resume normal activities within one to two weeks.

When to call your doctor about post-op problems

You should let your surgeon know if you have:

• A fever of more than 100.0 F.
• Difficulty breathing.
• New or increasing shortness of breath.
• Numbness, tingling, pain, or weakness in your arms or legs.
• Pain, redness, bleeding, drainage, or increased swelling at your treatment site.
• Severe pain that does not respond to medication.

What is the prognosis after an endoscopic sympathectomy?

Most people who have an endoscopic sympathectomy experience excellent short-term results and report improved quality of life. However, there is a small risk of symptom recurrence over time.

A few people may experience bothersome side effects. If these side effects are severe, additional surgery can reverse the procedure.

What is the success rate of an endoscopic sympathectomy?

The success rate of an endoscopic sympathectomy is greater than 95%. Nearly all people experience some symptom relief.

Why Choose UPMC for an Endoscopic Sympathectomy?

UPMC surgeons use the least invasive, most effective approach to treat all types of nerve disorders. Our team is at the forefront of some of the latest approaches to endoscopic sympathectomy — promoting safer procedures, improved outcomes, and enhanced quality of life.

By UPMC Editorial Staff. Last reviewed on 2025-05-16.