ETS – Endoscopic Thoracic Sympathectomy

What is ETS?

ETS stands for Endoscopic Transthoracic Sympathectomy, which is a surgery performed to solve the problem of Palmar Hyperhidrosis (sweaty hands) and in some cases Axillary Hyperhidrosis (sweaty underarms). The procedure involves the use of small instruments and cameras which allow the surgeon access to the sympathetic nerves which lead to excessive sweating. The surgeon then sets about separating those overactive nerves by snipping, clamping, or removing them all together.

The surgery itself lasts around half an hour to 45 minutes. During that time you’re put under general anaesthesia. You’re likely to have fully recovered within 1 to 3 days, and back to work within 1 to 2 weeks.

The Procedure

The steps involved in ETS:

1. Whilst under general anaesthesia, small incisions around a cm in length are made under the armpits.
2. Air then enters through the incisions made, temporarily collapsing the lung. This is so the surgeon can gain access to the sympathetic nerves.
3. The small instruments and camera are then inserted.
4. The surgeon then locates the sympathetic nerve chain which sits along the rib heads. It is there where the individual nerve ganglia responsible for hyperhidrosis reside.
5. The endoscopic instruments are then used to remove the overactive nerve nodes that are responsible for the excessive perspiration.
6. After removing these nerve nodes, the instruments are then taken out and the lung is re-inflated.
7. The incision made is then saturated.
8. This same method is then repeated under the other armpit.

You don’t have to worry about scarring as the incisions made are very small and will heal full relatively quickly.

Compensatory Sweating

ETS gets a lot of bad press because of this side effect to the surgery. Compensatory sweating is the result of the bodies’ apparent need to regulate its temperature. Because the body cannot produce sweat from the treated area anymore, an increase in sweating in other areas is expected. The compensatory sweating experienced can range from being minor to being completely unbearable. It’s usually experienced in areas such as the face, back of legs, thighs, bum, groin, chest, and back.

Sourced from International Hyperhidrosis Society:

In a study involving 121 patients at the Medical City Hospital of Dallas, Texas, compensatory sweating occurred in more than 80% of the patients undergoing ETS. Similarly, in a Danish study conducted at the Aarhus University Hospital, 90% of the patients undergoing ETS for underarm sweating, reported compensatory sweating, half of whom were forced to change their clothes during the day because of it.

Gustatory Sweating

This type compensatory sweating has also been known to occur in some patients. Gustatory sweating occurs when eating or smelling certain foods. This has been seen in around 10% of patients.

What Else to Consider

As I’ve mentioned, compensatory sweating can be equal or greater in terms of sweating than the original problem. However, there are many other things to consider such as complications, medical insurance, and whether or not you’ve exhausted other less extreme treatments such as Botox, Iontophoresis, strong antiperspirants and a combination of these treatments.

ETS should be considered a last resort option according to the majority of medical professionals, and it’s something that should be discussed thoroughly with both patient and doctor to fully understand both the positives and negatives of having the surgery.

Do your own research!

Before you make a decision on your surgery, be sure to tell your Dermatologist/Surgeon that you want to speak with patients they have performed ETS on. Find out whether or not these people have had success with the procedure, what effects they’ve suffered if any. Also, be sure to speak to patients who had their surgery over 2 years prior, as some side effects don’t occur until years after the surgery. Ask them whether or not they’d recommend the surgery to anyone else, and get their general satisfaction with the surgery itself. Grill your surgeon too; ask them about the percentages of patients who’ve suffered side effects such as compensatory sweating. Be strong and demanding as this is your body and your life we’re talking about!

What now?

Be 100% sure that all other less invasive treatments absolutely do not work for you. Start with prescription strength antiperspirants such as Drysol, try Iontophoresis with antiperspirants, give Botox a go too, and even prescription drugs such as Robinul and a combination of these treatments. Just remember, there’s no going back from ETS, the effects last forever. I don’t mean to put the frighteners on you, but I think it’s extremely important to fully understand the gravity of any procedure such as this. This is classed as major surgery. It should be your last resort, an act of desperation in my eyes.

I hope you found my insight into ETS helpful. I truly hope you find a resolution to your excessive sweating. GOOD LUCK, and be strong!

If you’ve got any opinions, success stories, or failures with this procedure, please submit your comments below and help fellow sufferers like you better understand ETS.