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(Endoscopic thoracic sympathectomy, ETS, thoracodorsal sympathectomy)

Procedure overview

Deep inside your chest, a structure called the sympathetic nerve chain runs up and down along your spine. During a sympathectomy, a surgeon cuts or clamps this nerve chain. This keeps nerve signals from passing through it.

Reasons for the procedure

This procedure is used to treat a condition called hyperhidrosis or heavy sweating in the palms of the hands, the face, the underarms, and sometimes the feet. It's also used for facial blushing, some chronic pain conditions and Raynaud phenomenon—a condition that leads to profound sensitivity to cold temperatures and color changes of the skin. After a sympathectomy, the brain can't send signals to the involved areas to make them sweat, blush, or react to the cold as much. This permanent procedure is used as a last resort if other steps, such as antiperspirants or medications, haven't worked. 

Risks of the procedure

As with any surgery that requires anesthesia, risks include breathing problems or reactions to the medications used to help you relax during the procedure. Other possible risks include:

  • Bleeding

  • Infection

  • Pain

  • More sweating in other parts of the body

  • Stroke or heart attack during the procedure

  • Collapsed lung

  • Injuries to nerves or blood vessels during the surgery

  • A problem called Horner’s syndrome, which is caused by nerve injury, and leads to eyelid drooping and trouble with the pupils of the eye.

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.

Before the procedure

Be sure to tell your doctor about any medicines or supplements you're taking. Discuss whether you should stop taking any of them before the procedure. You will probably need to avoid eating or drinking at midnight the night before the surgery.

During the procedure

Before the surgery, you will be put completely to sleep. You won't feel or remember the procedure. The surgeon will make two or three small incisions (cuts) on one side of your chest below your underarm. Next, your lung will be temporarily collapsed and moved aside to allow the surgeon to reach the nerve chain along your spine.

The surgeon will then insert a small video camera and surgical tools to view and maneuver the nerve chain. Next, the surgeon will cut or clamp the nerve chain at the right level, depending on your exact symptoms.

When finished, the surgeon will re-expand the lung, remove the camera and instruments and then the incision will be sewn shut. Then the surgeon will repeat the procedure on your other side. The entire surgery takes about an hour .

After the procedure

Most people can go home the day after the surgery. You may feel pain for a week afterward. Your doctor may suggest that you take over-the-counter or prescription pain medicine. Ask your health care team how to keep the incisions clean. Avoid soaking in the tub or going swimming for two weeks.

You can probably do your normal activities after the surgery, but you may need to take it easy at first. Most people can return to work within a week. Be sure to attend any follow-up visits that your doctor schedules.