Endoscopic Thoracic Sympathectomy

Endoscopic Thoracic Sympathectomy (ETS) is a surgical procedure used to treat hyperhidrosis, a condition characterized by excessive sweating, as well as other disorders such as facial blushing, Raynaud's disease, and certain types of facial pain. The procedure involves the interruption of part of the sympathetic nervous system located within the thoracic cavity, which is responsible for controlling the sweating mechanism.

Overview

Endoscopic Thoracic Sympathectomy is performed under general anesthesia. The surgeon makes two to three small incisions under the armpit. A tiny camera (endoscope) is inserted through one incision to visualize the sympathetic nerve chain on the side of the vertebral column. Through the other incisions, small instruments are used to either cut, clamp, or remove the sympathetic nerves responsible for excessive sweating in the hands, face, or armpits.

Indications

ETS is primarily indicated for severe cases of hyperhidrosis that have not responded to other treatments such as antiperspirants, iontophoresis, Botox injections, or medications. It may also be considered for patients with debilitating facial blushing, Raynaud's disease not responsive to medication, or certain types of facial pain that are linked to the sympathetic nervous system.

Risks and Complications

While ETS can be highly effective, it carries the risk of complications and side effects. The most common side effect is compensatory sweating, where the body compensates for the lack of sweating in the treated areas by sweating more in other areas. Other potential complications include Horner's syndrome (a rare condition that affects the eyes and face), pneumothorax (collapsed lung), nerve damage, and infection. It is crucial for patients to discuss the potential risks and benefits with their surgeon.

Procedure

The ETS procedure involves the following steps: 1. The patient is placed under general anesthesia. 2. Small incisions are made in the armpit area. 3. An endoscope is inserted through one incision to visualize the sympathetic nerve chain. 4. Surgical instruments are inserted through the other incisions to perform the sympathectomy by cutting, clamping, or removing the targeted nerves. 5. The incisions are closed with sutures or staples.

Recovery

Recovery from ETS surgery is relatively quick, with most patients being able to return home the same day. Pain and discomfort in the chest area can be expected but are usually manageable with pain medication. Patients are advised to avoid strenuous activities for a few weeks after the procedure. Follow-up appointments are necessary to monitor the patient's recovery and to evaluate the effectiveness of the surgery.

Effectiveness

ETS has been shown to be highly effective in reducing or eliminating excessive sweating in the treated areas. However, the success rate can vary depending on the specific condition being treated and the extent of the sympathectomy. Patients should have realistic expectations and discuss the potential outcomes with their surgeon.

Conclusion

Endoscopic Thoracic Sympathectomy is a minimally invasive surgical option for patients suffering from severe hyperhidrosis and other sympathetic nervous system disorders. While it offers a potential solution for those who have not found relief through other treatments, it is important for patients to carefully consider the risks and benefits.