Endoscopic Thoracic Sympathectomy

Are you suffering from excessive sweating or hyperhidrosis? If the condition is not remedied by antiperspirant, deodorants or even Botox, then an Endoscopic Thoracic Sympathectomy may be the last option.

Sympathectomy is an invasive surgery, which cuts or clamps the over-active sympathetic nerves (autonomous nervous system) that produce more sweat than the body normally requires. People with hyperhidrosis have sought medical help and the doctor’s final advice is a surgery called Endoscopic Thoracic Sympathectomy (ETS). Most doctors, however, would not readily suggest it because the side effects may often be severe and permanent. A highly trained thoracic surgeon can perform an ETS operation. Using endoscopic equipments, just a small incision can remedy excessive sweating or hyperhidrosis.

There are two types of hyperhidrosis: primary or localized hyperhidrosis and secondary hyperhidrosis. Primary hyperhidrosis can be further classified into:

  • Palmar hyperhidrosis (excessive sweating of the hands or palms)
  • Plantar hyperhidrosis (excessive foot or sole sweating)
  • Facial hyperhidrosis (excessive sweating of the face)
  • Axillary Hyperhidrosis   (excessive sweating of the armpits or underarm)

Secondary hyperhidrosis may be the result of some underlying medical conditions such as diabetes, gout, angina pectoris, hypertension, hyperthyroidism, and spinal cord injury. Or it may be due to side effects of certain medicines being taken.

In countries like the USA, UK and Canada, ETS has been reported to have more than 90% success rate in palmar hyperhidrosis although just around 80% on axillary hyperhidrosis. Generally, many patients claimed they are satisfied with the operation. The Swedish National Board of Health and Welfare reported that ETS conducted in various countries showed positive results and less side effects.

What Happens in an ETS Surgery

What is the procedure for an Endoscopic Thoracic Sympathectomy? An ETS is actually a surgery that stops the sympatikotomi nerve from sending signal for the sweat glands to produce and release sweat. Here’s what happens before, during, and after surgery.

Before the Surgery

Before your ETS surgery, you must inform your surgeon or nurse if you are pregnant. You will also be asked about what medicines, herbal supplements or vitamins you are currently taking and if you have any allergic reaction to certain types of medicines, too.

A few days before the surgery, your surgeon will ask you to refrain from taking any of your usual medicines that might affect the ability of your blood to clot such as aspirin,  ibuprofen, vitamin E, and warfarin but ask him what medicines you can continue especially if you are daily taking some. Smoking will also be stopped few days before the surgery.

During the Surgery

On the day of the surgery, you will be under general anesthesia and the surgery can take about 1 to 2 hours.

  • Endotracheal tube is inserted into the trachea (windpipe) for the patient to breathe
  • The surgeon will make 2 or 3 tiny incisions  on each arm.
  • With the help of two special tubes which are 5 mm in diameter inserted between the ribs under the arm, the two lungs are partially collapsed.
  • While the surgeon allows the lung to “breathe” normally through one of the cuts, he then will insert other smaller tools in the other cut like the thoracoscope (a telescope for the thorax) to identify the sympathetic nerves.
  • The surgeon can apply a titanium clamp   also referred to asendoscopic sympathetic blockade (ESB), to the section of the sympathetic nerve and the nerves remained undestroyed. The advantage of the method is the possibility of reactivating he nerves in the future by removing the clamps.
  • Another method is to cut the significant nerve to permanently stop sweating. This is known as electro-cautery. However, when choosing this method, there will be   intricacy in reconstructing the sympathetic nerves after the operation.
  • Then the lungs will be inflated to restore normal breathing.
  • After removing the ports, the small incisions will be sutured with nylon and applied with water-proof dressing.
  • If the sweating problem is on both sides, the surgeon will do the same procedure on the other side of the body.

After the Surgery

After the surgery, the doctor will prescribe a pain reliever. Instructions on how to wash the surgical cuts will be given prior to being discharged. The wounds should be kept clean and bandaged and must avoid being soaked in water for two weeks. Returning to work and doing regular activity will be allowed after a week or two.

Possible Complications

Just like any invasive surgery, some complications may arise. However, no reported data have been recorded on ETS. The following though are some of the minor complications that may be encountered:

  • Horner’s Syndrome: Damaged thoracic nerve nodes or the ganglion stellatum in the upper area may cause slightly smaller pupil affecting the asymmetry of the face due to a slightly drooping upper eye-lid.
  • Treatment Failure: This may rarely happen if patients have had no pleural disease.
  • Pneumothorax: Failure to resuction the inflated air may cause this.

Possible Side Effects

Minimal side effects have been reported by patients who underwent ETS. Here are some of the possible ETS side effects:

  • After anesthesia has been given, patients may experience allergic reaction to medications or breathing problems.
  • Compensatory sweating which is noticeable or very disturbing. Sweating can occur after surgery in other locations on the trunk or on the thighs, especially during work out or high external temperature.
  • During surgery, risks are higher that patient will have bleeding, heart attack or stroke or infection. He may also experience hemothorax or blood collection in the chest, arteries or nerves.

The complications and side effects will be avoided if all necessary information about the patient’s medical history has been provided. Remember that the surgeon will not insist on this procedure if the patient has no very satisfactory medical history.

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