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Endoscopic Thoracic Sympathectomy

Endoscopic Thoracic Sympathectomy (ETS) is a minimally invasive procedure that is performed with the goal of minimizing nerve stimulation which causes hyperhidrosis (excessive sweating) of the palms (palmar hyperhidrosis). It is also a permanent and so far the most effective solution for treating sweaty palms.

The procedure can also be used for axillary hyperhidrosis (excessive sweating of the underarms), and plantar hyperhidrosis (excessive sweating of the feet). However, the results for these vary from widely.

Although sweating is a normal body function, for some people their nervous system can be overactive causing them to experience excessive sweating in specific areas of the body. This not only makes them uncomfortable but also leads to social embarrassment and difficulty with certain practical tasks such as shaking hands or holding a pen.

The sympathetic nerves are responsible for controlling sweating, and during Endoscopic Thoracic Sympathectomy procedure, the surgeon severs this nerve chain which leads to the part of the body where hyperhidrosis occurs, in this case the palms.

Causes of Sweaty Palms

Palmar hyperhidrosis is a genetic condition associated with certain medical conditions or other forms of hyperhidrosis. Sweaty palms are caused by overstimulation of the sympathetic nerve chain. Some of the conditions that contribute to overactive sweat glands include:

  • Infections
  • Anxiety
  • Substance abuse
  • Certain medications
  • Hyperthyroidism
  • Heart conditions
  • Lung conditions
  • Stroke
  • Menopause
  • Tuberculosis
  • Parkinson’s disease
  • Glucose conditions

Symptoms of Palmar Hyperhidrosis

The symptoms of sweaty palms first begin to show when a person is a child and increases as he/she hits puberty. By the time the person reaches their 40s or 50s, the symptoms decrease as long as they are not caused by an underlying condition.

These symptoms include:

  • Clammy or wet palms that make you feel uneasy or uncomfortable when you are writing, typing, handling paper, or shaking other people’s hands.
  • Sweating that happens without any trigger.
  • Anxiety and stress can increase sweating.

Diagnosis of Sweaty Palms

Diagnosing palmar hyperhidrosis is made by a medical practitioner with a subspecialty in the condition as well as a Thoracic Surgeon with an interest in Endoscopic Thoracic Sympathectomy procedure. He/she will take down your medical history and ask you about your symptoms. You will also be asked about the timing and pattern of the sweating and if anyone else in your family has the condition.

Diagnosing palms hyperhidrosis requires that the sweating to have been excessive and has lasted more than six months without any known trigger.

If there is no underlying medical condition that is causing the sweaty palms, your practitioner will perform the following diagnostic tests:

  • Paper test: This involves placing a specific type of paper on the palms so it can absorb the sweat. The paper is then weighed to find out the amount of sweat.
  • Starch-iodine test. The practitioner will apply an iodine solution to the palms and once it dries, he/she will sprinkle the area with starch. The iodine and starch solution will turn the areas of excess sweat a dark blue color.

Ideal Candidate for Endoscopic Thoracic Sympathectomy procedure

ETS is performed on individuals who are experiencing heavier than normal sweating on their palms. The Endoscopic Thoracic Sympathectomy procedure is only done when other forms of treatment to reduce the excessive sweating have failed to work. It may also be used to treat excessive sweating in the facial area.

Pre-procedure Guidelines

During the consultation with the Thoracic Surgeon, and once he/she has determined that you can undergo ETS, you will be requested to:

  • Disclose the kind of medication, herbs, or supplements that you currently taking
  • Disclose whether you are pregnant
  • Avoid taking any blood-thinning medication such as aspirin and ibuprofen
  • Stop smoking as this will contribute to a lengthy recovery period

The Procedure

Endoscopic Thoracic Sympathectomy procedure is performed under general anesthesia and takes about 1-3 hours. During the procedure, the thoracic surgeon will create a small incision just below the armpit. The lung that is on the side that is being operated on will be made to collapse a little to create room for the procedure. The collapsed lung however does not affect the supply of air to the body as the other lung will be intact and capable of doing all the necessary functions of a lung.

An endoscope is advanced into the chest making the nerves that are supposed to be cut visible. Another small incision is made in which the surgical instruments are put through to cut the sympathetic nerves. The instruments can also be put through the same incision as the endoscope. Once the nerves have been divided/cut, the collapsed lung is inflated again, and the instruments are withdrawn.

The incisions are closed with sutures, and a drainage tube may be left attached for a few hours in the chest cavity to make sure all the air comes out and none is left trapped inside. The ETS procedure is repeated on the other side.

Post-op Guidelines

After the ETS procedure, most individuals spend about one night at the hospital, but the actual length of hospital stay varies from one patient to the next. The patient will experience some degree of pain and/or discomfort for a few days. However, this is controlled with prescription pain medication and antibiotics to prevent any risk of infection.

The patient will then be given instructions on how to take care of the incisions, how and when to change the dressings, and when he/she can resume regular activities.

Risks of ETS

ETS is a relatively low-risk procedure but just like any other surgical procedure, there may be possible risks associated with it. These include:

  • Infection
  • Breathing problems
  • Hemothorax
  • Pneumothorax
  • Nerve damage
  • Horner syndrome
  • Increased sweating
  • Pneumonia
  • Slow heartbeat

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