ETS Surgery

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Most of us do not know the torture that a person with hyperhidrosis endures every single day of their life; these unfortunates experience sweating to a degree that most people only experience following prolonged exposure to extreme heat, and they endure this on a daily basis. This makes life almost impossible, because the person cannot handle social situations for fear of showing their sweat stains. Such a patient is a prime candidate for ETS surgery, or endoscopic thoracic sympathectomy. These conditions are quite serious to the person who suffers from them, and when medications and other palliative measures have failed, the patient and their physician will turn to ETS surgery.

ETS surgery was first performed in 1889, by a Dr. Alexander. Physicians and learned that the autonomic nervous system, which controls all involuntary responses in the body, is connected to virtually all organs, all glands, and most particularly, all muscles. Initially, surgeons performed this procedure for a wide variety of conditions; for example, it was felt that a goiter could be cured by a sympathectomy. We now know that a goiter is due to an insufficiency of iodine in the diet. Surgeons even performed sympathectomy is in patients with angina pectoris and glaucoma, which to most of us today seems ridiculous.

To understand how ETS surgery works, it is first necessary to understand the anatomy of the sympathetic nerves. There are two trunks of sympathetic nerves. These consist of long chains of nerve cells, known as ganglia. Each of these trunks is composed of three regions: the cervical region (neck), the thoracic region (chest) and finally, the lumbar region (lower back). Most sympathectomies are performed at the lumbar area, between L1 and L5, or the first and fifth thoracic vertebrae. To the layperson, it is easier to understand if you refer to the area of the back between the belt line and the posterior.

In 1920 a surgeon named Kotzareff demonstrated that patients who had ETS surgery experienced improvements of their hyperhidrosis symptoms. The result was a condition known as anhidrosis, which is the complete inability to sweat. Similar procedures were developed for the lumbar region and were particularly effective in many cases with patients who had plantar hyperhidrosis, or hyperhidrosis of the feet.

The original sympathectomy procedure was performed using two basic approaches. The first, the posterior approach, was developed about 1908. This involved resecting ribs to reach the sympathetic nerves. In 1935 , the second approach was developed, which was somewhat less painful than the posterior approach. This was known as the supraclavicular approach as it entailed going in from above the patient's collarbone. However, there was a tendency with this approach for damage to occur to essential nerves and blood vessels. The current and most favored method, ETS surgery, was developed by doctors in Sweden in the late 1980s. This is an endoscopic procedure, and therefore is much less invasive than either the posterior or the supraclavicular approach.

No surgery is without a certain degree of risk, and ETS surgery is no exception. That having been said, however, in cases where the patient experiences socially disabling hyperhidrosis - whether in the face, head, armpits, groin, or feet - and other types of treatment have failed, this may be the only option.

The desired outcome of ETS surgery is, of course, resolution of the patient's symptoms. The most common reason for this procedure is hyperhidrosis. The procedure, as practiced today, involves one or more incisions, most typically in the axillary or armpit region. The physician inserts the endoscope into one of the incisions, which are generally about the size of a soda straw, and in the other, the surgical instrument. The sympathetic nerve tissue is then dissected. Some surgeons prefer to use small clamps to interrupt the messages from the brain to the nerve that controls sweating or blushing. Carbon dioxide gas is used to move the patient's lung out of the way, so that the surgeon can complete the procedure. Only one side of the sympathetic ganglion chain is dissected at a time. Once the first side is done, then the physician moves to the second side. This is typically an outpatient procedure, and most patients return to work within two days. In most cases, patients can resume physical activity, such as sports, within a week.

While it is possible that the clamping technique used in some ETS surgery can be reversed, if done within a very short window of opportunity, most surgeons will tell you that this procedure is not reversible. As stated above, there are certain side effects that have been noted in some patients such as blood pressure changes, possible changes to thyroid function, and in some cases, patients experienced sweating in a different part of their body -- for example below the waist -- although it has been noted that many patients preferred this to having excessively sweaty palms, face, or armpits.

As is true with any surgical procedure, the risks and the potential benefits must be discussed exhaustively with your doctor. Get a second opinion, if you think one is warranted. Be very certain that you are psychologically prepared for any possible side effects, although they are rare. Weigh your options carefully, and then make your decision.

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