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Endoscopic Thoracic Sympathectomy (ETS) for Hyperhidrosis
General Surgery / Dec 7th, 2022 10:12 am     A+ | a-


Endoscopic thoracic sympathectomy is a surgical procedure in which a portion of the sympathetic nerve trunk in the thoracic region is destroyed. ETS is used to treat excessive sweating in certain parts of the body, facial blushing, Raynaud's disease, and reflex sympathetic dystrophy. Sympathectomy and its variations have been performed in thoracic surgery for more than 100 years. However, its indications have undergone profound modifications in this period. Likewise, since then the surgical technique has also evolved dramatically up to the minimally invasive techniques worldwide accessible in present days. Currently, primary hyperhidrosis is, by far, the main indication for thoracic sympathectomy, and this procedure is usually carried out thoracoscopically with excellent results. However, until today, hyperhidrosis is a part of thoracic surgery still surrounded by controversy, persisting as an open field over which some confusion still resides regarding its pathophysiology, terms definitions, and operative approaches. The aim of this article is to provide a wide but easily comprehensible review of the theme, discussing and clarifying the major concepts with respect to its clinical presentation, all the presently available treatment options and strategies with their potential benefits and risks, the adequate patient selection for sympathectomy, as well as the postoperative clinical results.

In primary hyperhidrosis, the excessive sweat is usually localized and can be described mostly as palmar (hands), axillar (armpits), and/or plantar (feet). Craniofacial hyperhidrosis can also occur, alone or with facial blushing. Patients with primary hyperhidrosis classically present with sweating complaints dating from the first decade of life (remarkably in hands) and during adolescence the symptoms normally become more relevant, leading to a negative impact on the quality of life (QoL). Physical, psychological, and emotional stresses tend to worsen the symptoms, which are not related to the ambient temperature and are clearly disproportional to it. Another important aspect of primary hyperhidrosis is that sweating episodes occur only when the patient is awake.

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