Endoscopic thoracic sympathectomy

Endoscopic Thoracic Sympathectomy (ETS) is a surgical procedure used to treat excessive sweating (hyperhidrosis), facial blushing, Raynaud's disease, and reflex sympathetic dystrophy by interrupting part of the sympathetic nervous system located within the thoracic region of the spine.

Overview

Endoscopic thoracic sympathectomy involves the cutting, clamping, or ablating of the sympathetic nerve chain that runs along the spine. The procedure is most commonly performed to treat severe cases of hyperhidrosis, particularly of the hands, face, and armpits. By disrupting the sympathetic nerves, ETS reduces the signals that cause excessive sweating in these areas.

Indications

ETS is primarily indicated for patients with severe hyperhidrosis that has not responded to other treatments such as antiperspirants, medications, or iontophoresis. It may also be considered for individuals suffering from severe facial blushing, Raynaud's disease, and reflex sympathetic dystrophy when conservative treatments have failed.

Procedure

The procedure is performed under general anesthesia. The surgeon makes two to three small incisions under the armpit. A thoracoscope (a small camera) and surgical instruments are inserted through these incisions. The surgeon then locates the sympathetic nerve chain and either clamps, cuts, or ablates it. The most common levels treated are T2 to T4 for hyperhidrosis of the hands and T3 to T4 for axillary sweating or facial blushing.

Risks and Complications

While ETS is generally safe, it carries the risk of complications such as compensatory sweating (sweating in new areas of the body), Horner's syndrome (a rare condition that affects the eyes and face), pneumothorax (collapsed lung), and nerve damage. Compensatory sweating is the most common side effect, occurring in a significant number of patients.

Outcomes

Many patients experience immediate and significant reductions in sweating in the targeted areas. However, the effectiveness and patient satisfaction rates can vary. Compensatory sweating can sometimes be severe and more problematic than the original sweating issue.

Controversy

ETS is a subject of controversy within the medical community due to its irreversible nature and the potential for serious side effects. Some experts argue that the risks do not justify the benefits for a condition that is not life-threatening. Patients are advised to consider all options and seek multiple opinions before proceeding with surgery.

See Also

• Hyperhidrosis
• Sympathetic nervous system
• Thoracoscopy
• Raynaud's disease