Endoscopic Thoracic Sympathectomy

ETS is an outpatient procedure that is considered the most effective way to treat severe hyperhidrosis and facial blushing. The operation interrupts the overactive sympathetic nerves that cause excessive sweating and facial blushing. These nerves are located in the chest cavity next to the spine. The operation is done under general anesthesia. The patient does not feel any pain and is asleep throughout the operation. A small 1/4 of an inch cosmetic incision is made under the armpit, and the surgeon inserts a small telescope with a miniature camera into the chest cavity.


The overactive sympathetic nerve and ganglia are identified. The Harmonic Scapel which is an ultrasonic vibrating device is used to carefully dissect a small segment of the sympathetic nerve without damaging the nerve or the surrounding structures.

The neural transmissions in these nerves are then interrupted precisely at a specific level either by clipping or by microcutting.

It is very important to perform this part of the operation with great precision to avoid complications.

The instruments are then removed, and the wounds are closed with internal sutures. Scars are minimal and well hidden. This procedure takes about 30 minutes on each side. The relief of sweating is immediately noticed by the patient upon waking up from anesthesia. Most patients can resume physical activity, and return back to work within one week or less.

Kuntz Nerves
In about 15-20% of population, the sympathetic chain is bypassed by the nerve Kuntz. During the ETS procedure, this nerve is also carefully looked for and its neural transmissions are interrupted. One of the reasons for failure of ETS procedure is not interrupting neural transmission in the nerve of Kuntz.