Endoscopic Thoracic Sympathectomy (ETS)

What is Endoscopic Thoracic Sympathectomy (ETS)

Endoscopic thoracic sympathectomy is a procedure to destroy or cut portions of a chain of nerves that runs along the spine inside the chest (sympathetic nerve chain). This is done to treat hyperhidrosis, a condition in which you sweat a lot (excessively).

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding inside the chest (hemothorax).
• Allergic reactions to medicines.
• Damage to a part of the sympathetic nerve chain (Horner syndrome), or to other structures or organs.
• Chest pain.
• Lung collapse (pneumothorax).
• Sweating in areas that were not affected before the surgery.

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.
• Ask your health care provider how your surgical site will be marked or identified.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• 2–3 small incisions will be made under your arm.
• Air will be removed from your lung on the side of the incisions (your lung will be collapsed).
• A tube that has a light and a camera on the end (endoscope) will be inserted through one incision to look inside your chest and find the sympathetic nerve chain. The camera will send images from the endoscope to a screen in the operating room.
• Surgical instruments will be inserted through your other incisions to cut or clamp the sympathetic chain.
• Your collapsed lung will be reinflated.
• Your incisions will be closed and may be covered with a bandage (dressing).
• If necessary, the procedure will be repeated on the other side of your chest.

This procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will be given pain medicine as needed.

Do not drive for 24 hours if you were given a sedative.

Summary

• Endoscopic thoracic sympathectomy (ETS) is done to treat hyperhidrosis, a condition in which you sweat a lot (excessively).
• This is a procedure to destroy or cut portions of a chain of nerves that runs along the spine inside the chest (sympathetic nerve chain).
• Ask your health care provider about changing or stopping your regular medicines before your procedure. This is especially important if you are taking diabetes medicines or blood thinners.
• This procedure involves using a tube with a light and camera on the end (endoscope) that sends images to a screen in the operating room. Your surgeon uses these images to help perform the procedure.
• You should notdrive for 24 hours after the procedure if you were given a sedative.

Care After Endoscopic Thoracic Sympathectomy

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have some pain in the incision area. You may be given pain medicine.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
• Do notdrive or use heavy machinery while taking prescription pain medicine.

Activity

• Do notlift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
• Avoid sitting for a long time without moving. Get up and move around one or more times every few hours.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

Bathing

• Do nottake baths, swim, or use a hot tub until your health care provider approves. You may take showers.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.

Check your incision area every day for signs of infection. Check for:

• Redness, swelling, or pain.
• Fluid or blood.
• Warmth.
• Pus or a bad smell.

General instructions

• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Do deep breathing exercises and cough regularly as told by your health care provider. This helps to clear mucus and prevent pneumonia. If it hurts to cough, try one of these methods to ease your pain when you cough:
  • Hold a pillow against your chest.
  • Place the palms of both hands over your incisions. This is called splinting.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have redness, swelling, or pain around your incision area.
• You have fluid or blood coming from your incision area.
• Your incision area feels warm to the touch.
• You have pus or a bad smell coming from your incision area.
• You have a fever.
• The pupil of one eye is larger than the other (Horner syndrome).

Get help right away if:

• You have chest pain.
• You have shortness of breath or difficulty breathing.
• You feel light-headed or weak, and your heart is beating fast.
• You feel anxious or restless.
• Your lips or fingers have a bluish color.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• After the procedure, it is common to have some pain in the incision area.
• Follow instructions from your health care provider about how to take care of your incisions.
• Get help right away if you have symptoms such as chest pain, difficulty breathing, and restlessness.