For those suffering from severe hyperhidrosis that hasn’t responded to other treatments, Endoscopic Thoracic Sympathectomy (ETS) may be considered as a last-resort option. ETS is a surgical procedure designed to permanently reduce excessive sweating by cutting or clamping the nerves that stimulate sweat glands. While the procedure can be highly effective, it’s also invasive and comes with potential risks, including permanent side effects.
In this article, we’ll explore how ETS works, who might be a good candidate, and the potential benefits and risks of undergoing the surgery. We’ll also discuss compensatory sweating, one of the most common side effects, and what you can expect post-surgery.
How ETS Surgery Works
ETS targets the sympathetic nervous system, which is responsible for regulating involuntary bodily functions like sweating. In people with hyperhidrosis, the nerves in this system are overactive, leading to excessive sweating. ETS aims to permanently disrupt this nerve activity by either cutting, clamping, or burning specific nerves that signal the sweat glands to activate.
Here’s a breakdown of how the surgery is performed:
- Endoscopic Procedure: ETS is performed endoscopically, meaning the surgeon makes small incisions in the chest wall to insert a tiny camera (endoscope) and surgical instruments. This minimally invasive approach helps reduce recovery time and scarring.
- Targeting Nerves: The surgeon identifies the sympathetic nerves that are responsible for excessive sweating in specific areas (such as the hands or face). These nerves are usually located along the spine.
- Cutting or Clamping: Depending on the type of surgery, the surgeon will either cut or clamp these nerves. Cutting the nerve offers a permanent solution, while clamping is considered a reversible option in some cases, as the clamp can be removed in future procedures.
- Sweat Reduction: Once the targeted nerves are cut or clamped, the nerve signals that trigger sweating in the treated area are disrupted, leading to a reduction in excessive sweating.
The procedure typically takes about 1 to 2 hours, and most patients can return home the same day. ETS is usually performed under general anesthesia, meaning you’ll be asleep during the surgery.
Who is a Candidate for ETS?
ETS is generally reserved for individuals with severe focal hyperhidrosis who have not responded to other treatments, such as prescription antiperspirants, oral medications, or Botox injections. Most candidates for ETS suffer from palmar hyperhidrosis (excessive sweating of the hands), as the surgery is particularly effective for this condition.
Here are some specific criteria that may make someone a good candidate for ETS:
- Palmar Hyperhidrosis: ETS is most commonly performed to treat sweaty hands, as this area tends to respond best to the surgery. Individuals with debilitating hand sweating that interferes with daily tasks (like typing, gripping objects, or handshaking) may consider ETS.
- Facial Hyperhidrosis: ETS can also be used to treat excessive sweating on the face, particularly for those who experience facial blushing along with sweating.
- Failed Non-Surgical Treatments: Candidates for ETS are typically people who have tried other hyperhidrosis treatments without success. This might include antiperspirants, iontophoresis, Botox, or oral medications.
- Willingness to Accept Risks: ETS carries significant risks, including compensatory sweating (increased sweating in other parts of the body), which may not be reversible. Candidates must be aware of these potential risks before deciding to undergo surgery.
Benefits of ETS
For individuals who are appropriate candidates, ETS offers several key benefits:
- Permanent Sweat Reduction: One of the biggest advantages of ETS is that it offers a permanent solution for excessive sweating in the treated areas. Unlike other treatments that require ongoing maintenance (such as Botox or iontophoresis), ETS provides long-term relief.
- Highly Effective for Palmar Hyperhidrosis: ETS has a very high success rate for reducing or eliminating excessive sweating in the hands. Studies show that 80-90% of patients who undergo ETS for palmar hyperhidrosis experience significant sweat reduction.
- Improved Quality of Life: For people whose lives are severely impacted by hyperhidrosis, ETS can dramatically improve daily life. Simple tasks like holding a pen, shaking hands, or using a touchscreen device become easier and more comfortable post-surgery.
Risks and Side Effects of ETS
While ETS can be effective, it also comes with significant risks, and the potential for side effects should be carefully weighed before deciding to undergo surgery. The most common and concerning side effect of ETS is compensatory sweating, which occurs when the body starts sweating more in areas that were not treated by the surgery.
- Compensatory Sweating: After ETS, many patients experience increased sweating in other parts of the body, such as the back, chest, abdomen, or thighs. This occurs because the body tries to compensate for the loss of sweating in the treated area. While compensatory sweating can be mild and manageable for some, others may find it severe and even more problematic than the original hyperhidrosis.
- Gustatory Sweating: Some patients experience gustatory sweating, which causes excessive sweating on the face or neck when eating certain foods, especially spicy or hot foods. This is a rarer side effect but can be distressing for some individuals.
- Pneumothorax (Collapsed Lung): As with any surgery involving the chest, there’s a small risk of pneumothorax, or collapsed lung. This occurs when air leaks into the space between the lung and chest wall. While rare, it is a serious complication that may require additional treatment.
- Reversal Not Always Possible: While some surgeons offer a reversible version of ETS using nerve clamps, the results may not always be fully reversible. Once the sympathetic nerves are cut or clamped, the effects are often permanent.
- Horner’s Syndrome: Another rare but serious complication of ETS is Horner’s syndrome, which can occur if the nerves near the eyes are affected during surgery. This can result in drooping eyelids, constricted pupils, and reduced sweating on one side of the face.
Compensatory Sweating: The Biggest Drawback
Compensatory sweating is by far the most common and troubling side effect of ETS. It occurs in a large percentage of patients—up to 50-80%—and can vary in severity. Some individuals experience mild compensatory sweating that only occurs during physical activity or in hot weather. Others, however, may experience severe compensatory sweating that can affect large areas of the body, making it difficult to manage.
There’s no way to predict who will experience compensatory sweating or how severe it will be, and there are currently no treatments to reverse this side effect. For many individuals, the risk of developing severe compensatory sweating is a major deterrent from pursuing ETS surgery.
Post-Surgery Recovery and Results
Recovery from ETS surgery is typically quick and relatively easy for most patients. Since the procedure is minimally invasive and involves small incisions, patients can usually return to normal activities within a week. Here’s what you can expect after surgery:
- Immediate Results: Many patients notice an immediate reduction in sweating in the treated area, especially for palmar hyperhidrosis. The hands, for example, may feel dry right after waking up from the procedure.
- Mild Discomfort: There may be some mild discomfort or soreness in the chest where the incisions were made, but this usually resolves within a few days to a week.
- Compensatory Sweating: As mentioned earlier, compensatory sweating may occur within the first few weeks after surgery. For some individuals, it can appear gradually over time.
Is ETS Right for You?
ETS can be a life-changing solution for people with severe hyperhidrosis, particularly those with palmar hyperhidrosis that hasn’t responded to other treatments. However, it’s important to thoroughly discuss the potential risks and benefits with your healthcare provider. The possibility of compensatory sweating, as well as other side effects, must be carefully considered before deciding to undergo surgery.
For individuals willing to accept the potential risks, ETS offers permanent, significant relief from excessive sweating and can dramatically improve quality of life. However, if the risks of compensatory sweating or other side effects are too high, non-surgical options like Botox, iontophoresis, or oral medications may be worth exploring further.
Conclusion
Endoscopic Thoracic Sympathectomy (ETS) is a powerful treatment option for people with severe hyperhidrosis, especially those suffering from sweaty hands or facial sweating. While it offers permanent sweat reduction in the treated areas, the potential for serious side effects like compensatory sweating makes it a decision that should be approached with caution. If you’re considering ETS, consult with a healthcare provider who specializes in hyperhidrosis to determine whether this procedure is the best option for your condition.