Endoscopic Thoracic Sympathectomy (ETS)

What is ETS?

Endoscopic Thoracic Sympathectomy (ETS) is surgical treatment offered for some types of excessive sweating. It is considered a last resort after medications and other conservative treatment have failed. The goal of ETS surgery is to decrease sweat gland activity by interrupting nerve signals traveling from the spinal column to sweat glands. ETS is used to treat excessive sweating in the underarms and palms. It is not used to treat sweating of the feet or lower body.

Do I Qualify for
ETS Treatment?

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Procedure

ETS is a minimally-invasive procedure performed under general anesthesia. A small camera and instruments are inserted through small incisions. Once the nerve regulating sweat glands is identified, it is either cut or clamped. After completing these steps on one side, the surgeon moves to the other side where the same procedure is followed. Each incision is closed with sutures and takes some time to heal completely. You can observe a video of the procedure here:

Risks

ETS is relatively safe in the hands of a proficient surgeon who is experienced and able to handle unexpected events with accuracy. However, as with any operation, ETS has some associated risks. The surgery requires pinpoint accuracy to avoid damage to the surrounding structures and nerves. Rarely, patients may bleed excessively in the chest cavity, however, this bleeding can be controlled using the camera and surgical instruments.

Some risks are unique to this procedure including:

  • Compensatory sweating occurs in almost all patients who have this procedure. As hand or underarm sweating diminishes, other parts of the body may sweat more. The location and intensity are variable and often decreases with time. Approximately 95% of patients find compensatory sweating much more manageable than hand or underarm sweating.
  • Bradycardia, or a slow heart rate, is extremely rare following ETS. Athletes should pay close attention to this point because the drop in heart rate may cause a considerable dip in optimum efficiency level.
  • Horner’s syndrome is extremely rare complication and may occur in 0.1% of patients. It may either be temporary or permanent and is caused by damage to nerves supplying the eyelid and pupil. Patients may notice a droopy eyelid and small pupil.

Do I Qualify for
ETS Treatment?

Schedule Your Free Consultation*
  • In-Person OR Video Call
  • Appointments available this week
  • Zero CO-Pay Consultation with PPO Insurance
Schedule Your Free Consultation*

ETS Preparation

Your doctor is the best source of information and biggest confidant for efficient treatment of medical problems. It’s important to update your doctor about changes in your health or medications. A comprehensive history, examination and diagnosis should be reached and discussed with your doctor before proceeding with ETS. Physician anesthesiologists will inquire about the health of your heart and lungs to ensure you can tolerate one-lung ventilation. The potential risks must be carefully considered, and you should understand the likelihood of compensatory sweating. ETS surgery is considered a last resort and conservative treatment such as medications or injections should be attempted first. If those treatments fail, ETS should be discussed with an expert surgeon.