What is Endoscopic Thoracic Sympathectomy (ETS)?
Endoscopic refers to a video camera offering a magnified view of the sympathetic nerves allowing precise accurate minimally invasive surgery.
Thoracic refers to the chest cavity. This procedure should be carried out by an experienced chest surgeon familiar with surrounding structures such as the lungs, heart, great vessels, and chest wall. Mr Sanjay Sharma is an experienced chest surgeon who operates on the chest nearly daily.
Sympathectomy refers to the division of the sympathetic nerves supplying the sweat glands to the hands and Head/Face, found over the second and third ribs.
The Procedure
Patients are admitted on the day of ETS surgery and are usually discharged on the same afternoon. The procedure is performed under general anaesthesia and takes approximately 30 minutes.
Using a small single 5mm skin incision a camera is inserted into the chest cavity. A new minimally invasive modification is that the lung is now not deflated. With the lung moving a good view of the sympathetic chain is achieved. This is accurately ablated using electrical energy called cautery. Dr Sharma is one of the few surgeons that can perform this procedure without deflating the lungs.
Once the nerve supply is interrupted to the hands or face, the sweat glands cease to work, producing instantaneous dry hands/faces seen in the operating theatre.
The incision is closed with a single suture and the procedure is repeated on the other side. Small dressings are applied. Patients are discharged on the same day of the hyperhidrosis surgery.
Post Operative Care
Due to the single incision minimally invasive procedure, most patients make an uncomplicated recovery being discharged the same day.
Patients go to recovery for an hour and return to the ward when awake. A chest X-ray is performed to ensure lung expansion. Pain relief is prescribed and food can be eaten.
Experienced chest surgery nurses will conduct regular observations ensuring rapid recovery. Patients are discharged with simple painkillers and a follow-up appointment in three weeks.
Where will this surgery be performed?
Mount Hospital, Perth
St John of God, Murdoch
Joondalup Health Campus, Joondalup
Hollywood Hospital, Nedlands
What are the risks?
Like all surgical procedures ETS surgery carries risks that most patients never experience. Perth Sweat Clinic aims to inform patients of all the potential complications that may be experienced.
- Dry Hands – this is the aim of the surgery, however, it can trouble a small minority of patients. This can be managed with moisturizer cream.
- Compensatory hyperhidrosis – Slightly increased sweating from the trunk or back which is usually mild. This may be experienced by up to 40% of patients or in some studies, even higher. This usually is not troublesome with a great majority of patients who are delighted with their dry hands/faces. In a small percentage of patients, this can be severe. In rare circumstances, patients regret the procedure. Once performed the procedure cannot be reversed. It is impossible to predict which patients will regret the surgery pre operatively. Compensatory hyperhidrosis usually settles with time.
- Pneumothorax/pleural inflammation – Air may be retained around the lungs. This is usually removed at the time of surgery. If large, a small tube may need to be inserted. Occasionally the lining of the chest(pleura) may become inflamed, causing pain. This settles with simple analgesics.
- Gustatory Hyperhidrosis – Increased sweating when eating spicy foods which may occur.
- Horner’s Syndrome is an extremely rare complication with experienced chest surgeons. Nerve fibres over the first rib supply the eye. Sympathectomy aims to divide the fibres over the second or third rib, well away from the first rib. If the fibres over the first rib are divided, the patient may have a droopy eyelid and a constricted pupil. The droopy eyelid can be corrected by an eye surgeon.
- Bradycardia – Slowing down of the pulse, which is of minimal clinical importance.
Book your consultation with Dr Sanjay Sharma, Cardiothoracic Surgeon, for a new beginning to see if you are suitable for the ETS procedure.
Note:
- The initial consultation will be charged at $100 with a valid referral
- The procedure is fully covered by Private Health Funds