Regional Surgery: Endoscopic Thoracic Sympathectomy (ETS)

Endoscopic thoracic sympathectomy (ETS) is a major surgical procedure that is considered a last resort treatment for sweating of the palms or sometimes underarms or facial sweating.

The procedure requires a general anaesthetic. Small incisions are made in the side of the chest, the lung deflated and the nerves that control sweating are then cut or clipped. A small camera (or endoscope) is inserted through one of the incisions so the surgeon can see what is being done. The lung is re-inflated and the procedure repeated on the opposite side.

The procedure itself is generally effective in reducing the sweating of the areas intended BUT a huge drawback is that patients who have had ETS surgery are likely to develop serious complications or side effects.

The complications and side-effects of ETS surgery can include:

  1. sweating of another part of the body (compensatory sweating) often the chest, back thighs and/or groin which can be worse than the sweating was of the treated areas,
  2. air getting trapped in the chest (pneumothrorax),
  3. damage to a nerve that causes the eyelid of the affected side to droop, the pupil of the eye to be small and the eye to appear shrunken into the eye socket.

Because such surgery carries such risks, it is important that the doctor proposing the procedure explains ETS and all the risks and benefits.

The National Institute for Health and Care Excellence (NICE) has produced guidance for patients and doctors on ETS.