Endoscopic transthoracic sympathectomy is the name given to a surgical procedure used to treat hyperhidrosis. It involves the transection of ganglia that belong to the sympathetic nervous system.
What is endoscopic transthoracic sympathectomy?
ETS is a minimally invasive surgical method used to treat excessive sweating (hyperhidrosis). Endoscopic transthoracic sympathectomy (ETS) is a minimally invasive surgical method used to treat excessive sweating (hyperhidrosis). Furthermore, peripheral circulatory disorders can be treated with this surgical procedure. The sympathetic nervous system is a part of the autonomic nervous system. Among other things, it sends signals to the blood vessels and sweat glands that belong to the peripheral circulation of the human body surface. The origin of the responsible nerve fibers lies within small clusters of nerve cells. These are called ganglia and are arranged along the spinal column. The ganglionic chain forms the sympathetic border cord. Its course extends from the vertebral bodies at the neck to the lumbar spine. By severing the nerve nodes, it is possible to successfully correct certain forms of hyperhidrosis, in which excessive sweating occurs. Whereas in earlier times mainly major surgical procedures with corresponding surgical risks were necessary for this purpose, nowadays endoscopic transthoracic sympathectomy is considered the best surgical treatment method. Thus, it has now completely replaced classic sympathectomy, which required a prolonged hospital stay.
Function, effect, and goals
Endoscopic transthoracic sympathectomy is used primarily for severe hyperhidrosis of the face or hands in which other treatment methods are unsuccessful. ETS is one of the minimally invasive surgical procedures and is considered to be relatively low risk. The method has been steadily improved in recent years and in most cases cures the excessive sweating. Especially people who suffer from a combination of hand and foot sweat can also hope for an improvement of the foot sweat through the operation. In contrast, endoscopic transthoracic sympathectomy is not suitable for the treatment of isolated foot sweat. Its therapy must be performed by lumbar sympathectomy in the abdominal cavity. Endoscopic transthoracic sympathectomy makes it possible to access the ganglia, which are located in the thoracic cavity, without major risks. The ganglia are responsible for secreting sweat from the face, hands, and armpits. Especially in case of armpit sweat, excellent surgical results are obtained. Almost all patients can be expected to improve their condition with ETS. At the beginning of the endoscopic transthoracic sympathectomy, the patient receives general anesthesia. To ensure that no visible scars remain, the surgeon makes the approach through a small skin incision in the axillary region. To introduce the surgical endoscope, a small amount of carbon dioxide is also introduced into the patient’s chest cavity in advance. With the help of the special endoscope, which was developed specifically for this surgical method, the physician is able to identify the corresponding nerve ganglia. These are cut or interrupted with high-frequency current. This is followed by suction of the carbon dioxide. The wound is closed again with suture material that can be reabsorbed. The surgeon then performs the same procedure on the other side of the breast. The whole operation takes no more than 30 minutes on both sides of the body. Usually, the patient is allowed to leave the clinic after a few days and resume his usual activities. Since most doctors avoid operating on both sides of the breast on the same day, two procedures usually have to be performed several weeks apart. However, this has the disadvantage of two general anesthesias. The cost of endoscopic transthoracic sympathectomy is usually covered by public health insurance.
Risks, side effects, and hazards
The risk of complications with ETS is considered relatively low. However, inconvenience may occur, resulting in a prolonged hospital stay.Horner’s syndrome is one of the most serious complications. This is caused by an injury to the stellate ganglion and often results in unilateral facial asymmetry. This results in a drooping eyelid. However, this problem can be easily avoided by accurate identification of the ganglia. Pneumothorax is another complication. This is caused by carbon dioxide residue or air between the chest wall and the lungs. Possible causes are a minor lung injury or insufficient aspiration of the gas. If it is a small pneumothorax, no treatment is necessary, as it recedes on its own after one to two days. If, on the other hand, there is a larger pneumothorax, but this is rare, it is aspirated for one to two days with the help of a drain. This complication can also usually be avoided by taking care when aspirating the gas or inserting the medical instruments. In some cases, endoscopic transthoracic sympathectomy may be unsuccessful, but this is extremely rare for experienced physicians. Reasons for failed surgery include severe preexisting disease of the pleura, making access to the limiting cord impossible. Anatomic abnormalities of the vessels covering the ganglia may also be considered as a possible cause. In the context of ETS, undesirable side effects such as compensatory sweating may also occur. This shows an increasing secretion of sweat on the legs and trunk. This process results from physical exertion or heat. In some cases, this shift in sweat production is very apparent.
