Endoscopic thoracic sympathectomy - Cure and causes of ETS

Hyperhidrosis or excessive sweating is believed to be secondary to over activity of the sympathetic nerves located in the chest cavity. Surgical treatment of hyperhidrosis involves interrupting the sympathetic nerves.

These nerves have 12 segments in the thoracic cavity from T1 to T12. This procedure is called endoscopic thoracic sympathectomy. In its different variations it is referred to as ETS, ETS-C, or ESB.

Sympathectomy is performed through small keyhole incisions in the underarm area under general anesthesia. The sympathetic nerves are then found in the thoracic cavity and are either cut, clamped or resected. Details of this surgery are well explained at

Sympathectomy can be achieved by various methods:

Sympathectomy by clamping or clipping (ETS-C / ESB)
In this method the sympathetic nerves are interrupted but not physically cut. This is accomplished by applying a titanium clip/clamp to the nerve. The pressure from the clamp interrupts the nerve signals through the sympathetic nerves. The sympathetic ganglia are not destroyed. The advantage of the method is the theoretical possibility of reconstructing the nerves in the future by removing the clamps.

Sympathectomy by cutting
In this method the sympathetic nerves are physically cut with scissors or electrocautery. The disadvantage of this method is that it is extremely difficult to reconstruct the sympathetic nerves in the future.

Sympathectomy by resecting the sympathetic nerves
Some surgeons prefer the removal of a segment of the sympathetic nerves. This method is effective in treating various forms of hyperhidrosis. However again it is extremely to reconstruct the sympathetic chain after this procedure.

The extent of sympathectomy
The extent or level of the endoscopic sympathetic blockade, ESB, varies according to the type of hyperhidrosis or facial blushing:

            Condition                         Level of ESB

            Facial Blushing                      T2
            Facial Sweating                T2 or T3
            Hand Sweating                 T3 or T4
            Underarm Sweating           T4 or T5


It is believed that by limiting the level of ESB to a specific segment of the sympathetic chain, compensatory sweating, the most common side effects of surgery, can be reduced.

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