Thoracic sympathectomy

What is thoracic sympathectomy?

Thoracic sympathectomy is surgery that treats excessive sweating (hyperhidrosis) or facial flushing. It is known as endoscopic thoracic sympathectomy (ETS), since it is performed with the endoscopic technique.

General anesthesia is used to perform this procedure.

Why is it performed?

This surgical treatment is indicated for patients who present hypersweating of the palms, alone or together with the armpits, feet and/or face.

It will only be applied when medical treatment has failed or has had few results in the patient.

What does it consist of?

In thoracic sympathectomy these nerves are cut to the part of the body that sweats too much. The surgery takes approximately 1 to 3 hours.

It is performed as follows:

  • The surgeon makes 2 or 3 incisions under one arm on the side where the excessive sweating occurs.
  • The lung on this side is deflated (collapsed), so that air does not get in and out of the lung during surgery. This helps the surgeon to work.
  • A tiny camera called an endoscope is inserted into the chest through one of the small cuts. The video from the camera appears on a monitor in the operating room. The surgeon watches the monitor while performing the surgery.
  • Other small tools are inserted through the other incisions.
  • Using these tools, the surgeon locates the nerves that control sweating in the problem area and cuts, clamps or destroys them.
  • The lung is inflated on this side.
  • The surgeon closes the incisions with sutures (stitches).
  • A small drainage tube may be left in the chest for a day.

After performing this procedure on one side of the body, the surgeon can do the same on the other side.

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Endoscopic thoracic sympathectomy (ETS) is used when medical treatment has failed or has had little effect on the patient.

Preparing for thoracic sympathectomy

Before undergoing this procedure, it is recommended that the patient inform his surgeon about:

  • If you are or could be pregnant
  • What medications, vitamins, herbs and other supplements you are taking, including those purchased without a prescription.

In the days before the surgery, the patient may be asked to stop taking anticoagulant medications and may be instructed to take any medications on the day of the surgery.

A fundamental recommendation is that the patient should try to quit smoking if he/she is a smoker, since smoking increases the risk of problems.

Care after surgery

After the intervention the patient will remain hospitalized for about 24 hours following the procedure. Full recovery occurs after 2-3 days, although pain may persist for about a week or two. Your specialist may recommend that you take analgesics to relieve pain.

The surgical incisions will require some care:

  • Keep the surgical incision areas clean, dry and covered with dressings (bandages).
  • Wash the areas and change the dressings as your doctor told you to.
  • Do not soak in a bathtub or Jacuzzi (whirlpool) or swim for about 2 weeks.

Slowly resume your regular activities to the best of your ability.

Alternatives to this treatment

Some alternatives to endoscopic thoracic sympathectomy are:

  • Microwave therapy: This therapy uses a device that emits microwave energy to destroy the sweat glands. The treatment consists of 20 to 30 minute sessions every three months. After the therapy the patient may feel a change in skin sensitivity and some discomfort, these are possible side effects.
  • Removal of sweat glands (Axillary surgery): If excessive sweating only occurs in the armpits, it may be helpful to remove the sweat glands.