Endoscopic Thoracic Sympathectomy

Some surgeries save lives, others make lives easier. One of the latter includes the endoscopic thoracic sympathectomy (ETS) - the surgery used to treat hyperhidrosis. 

Hyperhidrosis is a common medical condition characterized by excessive sweating due to overactive eccrine glands and not caused by temperature or exercise level. Over time, this may lead for the individual to suffer from itching and inflammation, strong body odour, and cracking or peeling skin. Depending on the severity of the symptoms, hyperhidrosis may also play an emotional role, with many people feeling embarrassment, anxiety, and the urge to become more anti-social, leading to a negative impact on their mental health. 

To treat this condition, healthcare providers and dermatologists suggest medications such as anticholinergic agents or antidepressants, as well as specialised treatments botulinum toxin injections or microwave therapy for more severe cases. ETS comes in when symptoms continue to occur after these treatments have all taken place.

ETS is a minimally invasive surgical procedure involving the cutting, clipping, or cauterizing of a section of the sympathetic nerve chain in the chest to turn off the signal that tells your glands to produce sweat. Surgery is performed under general anesthesia, allowing the patient to be asleep and pain free. From there, the surgeon makes small incisions along the underarm where excessive sweating takes place and the lung of that side is collapsed to provide the surgeon with more working space. A thoracoscope, as well as other cutting tools, are inserted through the incision, and the surgeon utilizes the video from the thoracoscope to cut, clip, or destroy the identified nerve. After this is completed, the lung is re-inflated and the cut is closed with sutures. The patient may also have to keep a small drainage tube in their chest for a day if the surgeon deems it necessary. 

Although ETS is a relatively simple surgery with a general success rate of over 95%, there are still certain risks to be aware of. Possible concerns include blood or air collection in the chest, damage to others arteries or nerves, pneumonia, Horner syndrome, slowing of the heartbeat. However, cases of these side effects are rare, with most patients only suffering from compensatory sweating. Despite these potential concerns, many patients remain satisfied with the results of ETS, with some studies showing satisfaction rates above 90%. 

In conclusion, ETS is one of the “last resort” treatments for hyperhidrosis, used only when other treatments or medications fail. The surgery itself is minimally invasive and relatively safe and successful, with permanent results that leave patients with a higher quality of life.

by Renee Wang at Incisionary

APA References

Cleveland Clinic. (n.d.). Hyperhidrosis: Types, Causes, Symptoms & Treatment. Cleveland Clinic. Retrieved October 6, 2025, from https://my.clevelandclinic.org/health/diseases/17113-hyperhidrosis

NIH Clinical Center. (2025, January 21). Endoscopic thoracic sympathectomy. MedlinePlus. Retrieved October 6, 2025, from https://medlineplus.gov/ency/article/007291.htm