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Endoscopic thoracic sympathectomy
Definition
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 surgery stops or turns off the nerve signals that tell the part of the body to sweat too much.
Alternative Names
Sympathectomy - endoscopic thoracic; ETC
Description
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. Your surgeon will use the monitor to do your surgery.
- Your 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.
- Your 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, your surgeon will do the same thing on the other side. The surgery takes about 1 - 3 hours.
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 for any anesthesia are:
- Allergic reactions to medicines
- Breathing problems
Risks for any surgery are:
- Bleeding
- Heart attack or stroke during surgery
- Infection
Risks for this procedure are:
- Blood collection in the chest (hemothorax)
- 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)
Surgeons who perform ETS must receive special training. Before having this surgery, make sure your surgeon has this training.
Before the Procedure
Always 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 drugs that make it hard for your blood to clot. Some of these are aspirin, ibuprofen (Advil, Motrin), vitamin E, and warfarin (Coumadin).
- Ask your doctor which drugs 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 midnight the night before surgery.
- Take the drugs your doctor told you to take with a small sip of water.
Your doctor or nurse will tell you when to arrive at the hospital.
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. Journal of the American College of Surgeons. March 2007;204(3).
Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
