ETS
(Endoscopic Thoracic Sympathectomy)

This technique involves, cutting or blocking (called ESB) or clamping (called ETS-C) of the sympathetic nerve. Clamping and blocking allows the procedure to be reversed as opposed to traditional ETS surgery in which the nerves are actually severed.

The reversibility of the procedures has been demonstrated to range between 3-6 months following surgery. There is no potential for reversal with the ETS cutting technique.

ETS is performed under a mild, general anesthesia and requires a skilled surgeon. The surgeons enter the chest cavity through small incisions (a mere 5 mm in diameter) located on each side of the body just under the armpit.

A small amount of carbon dioxide (a harmless gas) is introduced into the chest cavity in order to gently push the lung aside. This provides a very clear view of the sympathetic chain of nerves which is located along the spine inside the chest cavity.

The surgeons then expose the sympathetic ganglion chain and either cut or place small clamps over the nerve responsible for the sweating and/or blushing.

For hand sweating and underarm sweating, the clamps are placed over the 3rd and 4th ganglia (T3-T4) of the sympathetic nerve chain. This technique best targets hand and underarm sweating, and may also reduce facial sweating/ blushing.

For facial sweating and facial blushing, the clamps are placed over the second ganglion (T2) of the sympathetic nerve chain. This technique best targets facial sweating/blushing, as well as any hand sweating the patient may have.

After completion of the operation, the carbon dioxide gas is evacuated and the incisions are closed with an absorbable stitch which does not need removal. The procedure is then repeated on the other side. A chest X-ray is then performed to insure that the lungs are fully inflated.

The patient may resume work within 48 hours and return to sports activities in 5-7 days.

ETS should only be considered as a last resort for treatment of resistant cases that don't improve significantly through conventional therapy. Some doctors no longer recommended ETS for those who suffers only from facial blushing.