Endoscopic Thoracic Sympathectomy

Endoscopic thoracic sympathectomy (ETS) is a procedure to destroy or cut portions of a chain of nerves that run along the spine inside the chest (sympathetic nerve chain). This is done to treat hyperhidrosis, a condition in which a person sweats a lot.

Tell a health care provider about:

• Any allergies you have.

• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.

• Any problems you or family members have had with anesthetic medicines.

• Any bleeding problems you have.

• Any surgeries you have had.

• Any medical conditions you have.

• Whether you are pregnant or may be pregnant.

What are the risks?

What happens before the procedure?

When to stop eating and drinking

Follow instructions from your health care provider about what you may eat and drink. These may include:

• 8 hours before your procedure

  • Stop eating most foods. Do not eat meat, fried foods, or fatty foods.

  • Eat only light foods, such as toast or crackers.

  • All liquids are okay except energy drinks and alcohol.

• 6 hours before your procedure

  • Stop eating.

  • Drink only clear liquids, such as water, clear fruit juice, black coffee, plain tea, and sports drinks.

  • Do not drink energy drinks or alcohol.

• 2 hours before your procedure

  • Stop drinking all liquids.

  • You may be allowed to take medicines with small sips of water.

If you do not follow your health care provider’s instructions, your procedure may be delayed or canceled.

What happens during the procedure?

• An IV will be inserted into one of your veins.

• You will be given one or both of the following:

  • A medicine to help you relax (sedative).

  • A medicine to make you fall asleep (general anesthetic).

• Two to three small incisions will be made under your arm.

• Air will be removed from your lung on the side of the incisions. This is called collapsing the lung.

• A tube that has a light and a camera (endoscope) will be inserted through one incision to look inside your chest and find the sympathetic nerve chain. The camera will send images from the endoscope to a screen in the operating room.

• Surgical instruments will be inserted through your other incisions to cut or clamp the sympathetic chain.

• Your collapsed lung will be refilled with air.

• Your incisions will be closed with stitches (sutures), adhesive strips, or surgical glue. A bandage (dressing) may be placed over the incisions.

• If necessary, the procedure will be repeated on the other side of your chest.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.

• You will be given pain medicine as needed.

• If you were given a sedative during the procedure, it can affect you for several hours. Do not drive or operate machinery until your health care provider says that it is safe.

Summary

• Endoscopic thoracic sympathectomy (ETS) is done to treat hyperhidrosis, a condition in which you sweat a lot.

• This is a procedure to destroy or cut portions of the sympathetic nerve chain.

• Ask your health care provider about changing or stopping your regular medicines before your procedure, especially if you are taking diabetes medicines or blood thinners.

• This procedure involves using an endoscope that sends images to a screen in the operating room.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.