ETS

What is ETS?

Endoscopic thoracic sympathectomy (ETS) is a minimally invasive surgical procedure in which the sympathetic nerve chain is divided with the goal of reducing the nerve stimulation that causes excessive sweating of the palms. This nerve chain is located along each side of the spinal column in the thoracic (chest) cavity.

Is ETS right for me?

ETS is the most effective and permanent treatment for patients suffering from palmar hyperhidrosis. While many other areas of the body may sweat along with the palms, such as the feet and  underarms, our surgeons only recommend the ETS procedure when patients are also suffering from excessive sweating of the palms.  

When performed in patients that have palmar hyperhidrosis, the ETS procedure has also resulted in improvement or resolution of axillary and plantar hyperhidrosis. While resolution of palmar hyperhidrosis is extremely high (more than 99%), the results for axillary and plantar hyperhidrosis vary from patient to patient. 

What can I expect during ETS?

The ETS procedure is performed in an outpatient hospital setting by our surgical team lead by Dr. Bocage. General anesthesia is used and the procedural time typically takes less than one hour.  

A thin, flexible tube with a camera at its tip (a thoracoscope) is inserted into a small incision (about 5mm) under each armpit.  The thoracoscope provides the surgeons with superior visualization of the sympathetic nerve chain located in the chest. An additional tiny incision is made to allow access for the surgical instruments used to divide the sympathetic nerve chain.  

Upon completion, patients awaken with warm dry hands and are able to return home within hours. 

What is the recovery time for ETS?

Recovery after ETS is swift, with most patients returning home the day of the procedure and back to normal activity within days to a week. Patients must schedule a postoperative visit with their surgeon for approximately one to two weeks following the procedure.

What are the possible risks and side effects from ETS?

The most common side effect of ETS is compensatory sweating, which typically presents as sweating of the legs, abdomen and/or back. Compensatory sweating reportedly occurs in approximately 40% of patients who have undergone the ETS procedure. In our experience, most patients who experience compensatory sweating following ETS report that it is mild and manageable. If necessary, there are medications that can help reduce sweating in the rare cases where compensatory sweating is more severe.  

 As with any surgery, there are some risks, though the chances are low. These may include pain, infection and bleeding. The surgeon will review all potential risks and complications in a consultation prior to surgery.

Why choose the Hyperhidrosis Center at Thoracic Group for your ETS procedure?

Thoracic Group surgeons were among the first in the world to perform minimally invasive surgery in the chest. They have continued to improve and teach the procedure, bringing its surgical and health benefits to surgeons and patients around the world.   

Dr. Bocage has refined and expanded the practice of minimally invasive thoracic surgery, applying the technique to all procedures in the chest, including ETS. They perform all surgical procedures as a team, which directly contributes to shortened operative times, operating room efficiency, excellent outcomes and superior patient satisfaction. To date, Dr. Bocage and his team have performed more than 8000 minimally invasive thoracic surgical procedures.

Is ETS covered by insurance?

Many major insurance carriers provide coverage for ETS. Our experienced insurance team reviews each patient’s plan to check benefits, coverage and any possible preoperative requirements.

In the event of non-coverage or any additional out-of-pocket expenses associated with the procedure, we offer financing and payment plans to make the payment process as easy as possible. FSA and HSA funds may also be utilized for any out-of-pocket costs that arise.