Endoscopic thoracic sympathectomy (ETS) is a surgical procedure involving the division of the sympathetic nerves that control some of the body’s involuntary responses to external stimuli.

Two common disorders treated by this procedure are:

• Reflex sympathetic dystrophy (RSD): Abnormal chronic pain in one of the limbs
• Hyperhidrosis: Excessive sweating

This surgery can be used to treat sweating in the palms or face, and turns off the nerve signals that tell those parts of the body to sweat. ETS is only used when other treatments to reduce sweating have failed. Other treatments include:

• Topical drying agents
• Oral medications
• Botox® injections

Although ETS is highly effective at reducing sweating in the palms or face, the most common side effect is sweating in other parts of the body, such as the back or chest. While mild in many cases, the sweating can become severe. Surgery is therefore reserved for those who have failed at more conservative therapies.

During the procedure

• You will receive general anesthesia for the surgery.
• Your surgeon will then make two or three tiny incisions under each arm.
• Your lung on the side being operated on will be deflated to give the surgeon more room to work.
• A thin tube topped with a tiny camera will be inserted into your chest. This endoscope will then display images that your surgeon will use to perform your surgery.
• Additional small tools will be placed through the other incisions.
• The surgeon will find the nerves that control sweating in the problem area, and these nerves will be cut or clipped.
• Your lung will then be reinflated and the procedure repeated on the other side of your chest.
• Your surgeon will close the incisions with stitches (sutures).