Endoscopic thoracic sympathectomy is used mainly as a treatment for excessive sweating (hyperhidrosis) but can also be used to help treat extreme facial flushing. The following topics are covered in this section:

Heavy sweating
Sweating is one of the ways we regulate our body temperature. It also helps keep our skin moist. Sweat is produced by thousands of tiny glands in the skin. These glands are controlled by our sympathetic nervous system.

Many people occasionally experience excessive sweating, especially when they are anxious or under stress. This can often be achieved with simple measures such as strong antiperspirants. However, in some people (around 1% of the population) the nervous system is overactive and causes sweating in certain places in the body, often at inappropriate times. Excessive sweating (the medical term is hyperhidrosis) can affect the hands, armpits, and feet. This can be a serious problem, leading to social embarrassment and difficulty with practical tasks like holding a pen.

Before considering any surgical treatment, try simple measures and be aware that a big problem persists even though attempts are made to address it.

What is an endoscopic thoracic sympathectomy? (ETS)
With an ETS, these sympathetic nerves are cut, which turns sweating off. The sympathetic nerves that control the sweat glands in the hand and armpits run in the rib cage near the chest. The development of surgical telescopes and cameras has meant that these nerves can be divided by very small incisions, which can improve symptoms.

The operation
This operation is performed under general anesthesia. A small incision is made under the armpit. The lungs on the side being operated on are allowed to collapse a little to make room for the operation. Your other lungs will remain intact and free to do all the work. A camera on a thin telescope is inserted into the chest and the nerves to be divided are found. Another small hole can be put in the instruments that divide the nerves, although this can also be done in the same hole as for the camera. After the nerves are cut, the lungs are expanded again and the instruments removed. Sometimes a small drain (plastic tube) is left in the chest for a few hours to ensure that all of the air is removed from the chest cavity.

Your surgeon will discuss with you whether it is advisable to do both sides at the same time. The operation can be performed as a day operation or with an overnight stay if you need to operate on both sides.

How successful is it?
ETS is very effective at stopping hand sweating more than 95% of the time. It is slightly less effective at stopping armpit sweating (around 85%). Over time, some people will return to sweating. In a study in patients over a period of 15 years:

93% reported a complete cure from sweating
67% were completely satisfied
27% were partially satisfied and would have the operation again
7% said they would not have the surgery again

What are the downsides?
ETS is usually very successful and most people are very happy with their surgery. However, it is very important to know that ETS usually leads to increased sweating elsewhere. This is known as compensatory hyperhidrosis and usually occurs on the chest or back. This happens to some extent in almost everyone who has had ETS, although for the vast majority of those affected it is usually much less of a problem than initial sweating in the hands or armpits. To some extent, surgery can be viewed as a way to move the sweating from your hands to another location rather than stopping it entirely.

About one in a hundred people has profuse sweating, which can be a major problem. It is impossible to predict who will receive this, and it is important to realize that the surgery is designed to be irreversible. Sometimes people notice sweating when they eat spicy or spicy food (this is called taste sweating).

What are the risks?
ETS is a safe operation and normally there are no problems. As with any surgery, problems can arise and there is little risk of injury to the chest. If air leaks from the lungs or bleeds, a drainage tube may need to be inserted into the chest for a day or two. Very rarely, breast surgery may be necessary to resolve problems.

ETS can cause droopy eyelids (called Horner’s syndrome) in about 1 in 100 people, which usually recover over time, but not in all cases.

What are the alternative treatments?
Antiperspirants: They usually need to be used liberally and regularly.

Botox Injections: Botox blocks the nerve signals to the sweat glands and prevents the sympathetic nerves from working. The effects are temporary but usually last around six months. Treating sweating in the hands requires a large number of injections into the palms of the hands and fingers, which are uncomfortable and can occasionally cause areas of (temporary) numbness and weakness. Few people continue to use botox injections to make their hands sweat when it works. In contrast, Botox is a great way to treat excessive armpit sweating. Injections under the arm don’t cause as much discomfort but need to be repeated every six to nine months on average.

Iontophoresis: A machine is used to conduct electrical currents through the skin. How exactly it works is not fully understood, but some people find it very helpful. The machines can be purchased for home use.

Which treatment suits me?
In order to decide which treatment is best for you, please consider the following questions:

  1. Have you tried simple measures like antiperspirants or iontophoresis?
  2. Did the simple measures fail?
  3. Is the extra sweating seriously affecting your life? If the answer is yes to all of these questions, go to question 4.
  4. Does sweating affect your hands?

If so, consider ETS
If not, consider botox

  1. Does sweating affect your armpits?

If it’s hands and armpits, consider ETS
If it’s only about the armpits, consider botox
ETS for facial flushing / flushing
Most people occasionally blush, especially when they feel embarrassed or stressed out. The flushing is caused by blood vessels in the opening of the skin that allow more blood to flow through, making the skin red. The muscles in your blood vessels are controlled by the sympathetic nervous system. Some people find that they get so red that it becomes a huge problem in their social and professional life.

ETS helps reduce facial flushing as the sympathetic nerves control the supply of extra blood to the skin. The use of ETS to treat facial redness is not as well established as its use in treating excessive sweating, but it is effective. It works best for sudden redness. It is not useful for people with a reddish complexion.

It’s important to make sure that there isn’t an underlying skin condition that is causing the problem, such as: B. the skin condition rosacea, or that flushing does not occur as part of menopause. The possible downsides are the same as with ETS for excessive sweating, but it is also conceivable that if the procedure works for one side rather than the other, then half of your face will turn red.

It only makes sense to consider ETS if you have a major problem with sweating or flushing that is seriously affecting your quality of life, and if you’ve tried other treatments and they haven’t worked. The surgery is usually very successful and most people are delighted. However, some compensatory sweating is common and it is occasionally a major problem. There is inevitably some risk associated with surgery, and while the chances of a serious problem are very small, you could be the one to develop it. You should consider your options carefully and discuss the surgery with someone who does it on a regular basis.