Endoscopic Thoracic Sympathectomy

ENDOSCOPIC THORACIC SYMPATHECTOMY

Endoscopic Thoracic Sympathectomy (ETS) is an effective treatment of hyperhidrosis (excessive sweating) and facial blushing.

ETS EXPLAINED

Sweating (hyperhidrosis) is caused by over-stimulation of the sweat glands by the sympathetic nerves, and in most cases, there is no other underlying disorder. The palms of the hands and the soles of the feet have the highest concentration of sweat glands and therefore these two areas are most commonly affected by hyperhidrosis. Hyperhidrosis can also affect the armpits, face, scalp and body.
Over-stimulation of the sympathetic nerves can also cause excessive facial blushing.
ETS is an operation performed under general anesthesia, which involves ablation of the sympathetic chain in the chest using minimally invasive surgery.It calms the sympathetic nerves of the upper body that are overactive in people with excessive hand sweating and/or facial blushing.

What does the operation involve?

Once under anesthesia, the surgeon inserts two very small ports (5mm) into the chest, between the ribs in the armpit. The lung is partially collapsed, exposing the sympathetic chain which contains the sympathetic nerve cells. A clear, uninterrupted view of the sympathectomy chain is obtained and this is ablated.
Ablation of the sympathetic nerve is accomplished by diathermy or electro-cautery of the relevant section of the chain. Afterwards, the lung is fully re-inflated and normal “breathing” is restored on that side. The ports are removed and the small incisions are closed with a solitary nylon stitch and water-proof dressing is applied.

POST OPERATIVE RISKS

  • Rebound hyperhidrosis This is excessive sweating which occurs on the back and chest to some degree in about 30 to 40% of patients. Some studies suggest the incidence is higher. For most patients this is not troublesome and settles spontaneously. However, in 2-5% of patients, rebound sweating can be severe and disabling. In rare cases the rebound is so severe the patient regrets the operation. Unfortunately, it cannot be reversed with further surgery. Some patients, for example those with facial/scalp sweating and older patients are at greater risk.

  • Pneumothorax - air around the lung. This is uncommon and when it occurs is usually small, not noticed by the patient, and does not require treatment. However, if it causes shortness of breath, the air can be allowed to escape through a small tube placed in the chest. This will delay discharge from hospital by a day or two.

  • Horner’s Syndrome This occurs if there is interference of the sympathetic supply to the eye. The pupil becomes constricted and the eyelid may droop. This is extremely rare (1-2 in 1000 cases).

  • Pain may be experienced in the back due to inflammation in the lining of the lung, which settles with anti-inflammatories. In addition, it is common for the ribs to feel sore, but this is easily controlled with simple analgesia.

  • Pleurisy may occur due to inflammation of the lining of the lung (pleura). This occurs commonly 2 or 3 days after the procedure. It is often perceived as a pulled muscle between the shoulder blades. It can sometimes cause severe pain, but is usually controlled with anti-inflammatories. It invariably settles spontaneously.

  • Dry hands! Although this is the aim for many patients, those undergoing sympathectomy for other causes such as facial blushing or axillary hyperhidrosis need to be warned of this. This problem is easily remedied with moisturisers.

  • Gustatory sweating involves facial sweating following meals, particular spicy foods. This occurs to some extent in 5 to 10% of patients.

  • Bradycardia or slowing of the pulse may occur but is never of any clinical significance.

FAQs

  • How does ETS work?
  • ETS is an operation performed under general anesthesia, which involves ablation of the sympathetic chain in the chest using minimally invasive surgery. It calms the sympathetic nerves of the upper body that are overactive in people with excessive hand sweating and/or facial blushing.

  • Will ETS be a permanent solution?
  • Yes, for nearly all patients ETS provides long-lasting relief.

  • What are risks with ETS treatment?
  • As with all surgeries, there are some minor risks involved in ETS treatment. These may include side effects from general anesthesia, rebound hyperhidrosis (excessive sweating) in the back or chest area, localised pain, pneumothorax (air around the lung), and pleurisy. Most of these side effects are rare, temporary and can be relieved with over-the-counter remedies. Please see below for a full list of post-operative risks or speak with one of our team members.

  • How long will I need to be off work or school?
  • Recovery times vary from patient to patient, but most people can expect to resume their usual activities within one week - many in fact return earlier.

  • What are the costs of ETS treatment?
  • Costs will vary depending on the individual and their symptoms. For your individual cost estimate please contact one of our team members today for a consultation.

Endoscopic Thoracic Sympathectomy