ETS (Endoscopic Thoratic Sympathectomy)

Stands for endoscopic thorasis sympathectomy. Open sympathectomy was done for the last 70 years. The endoscopic approach was developed over the last decade. E.T.S made it possible to perform the operation on an outpatient basis with a very high success rate (98%). The E.T.S is divided into excision of the nerve, cutting it with electrocautery, or ultrasonic waves or clamping the nerve. All methods are equally effective but the clamping method gives a possibility for reversal in the instance that the clips may be removed if compensatory sweating is too severe and the patient can not tolerate it. A good example of the procedure step by step can be seen at The Center For Hyperhidrosis with the slide show he has made there recently.

It is still yet to be proven that removal of the clamps will provide total reversibility. It is a better option than the cutting method for which the reversal procedure with a nerve graft is much more complicated and the results are still not known.

The cutting method can be done through a one hole incision or two hole incisions between 3mm to 7mm. The clamping method has to be done through two hole incisions. In either method the cosmetic results are superb.

There is debate as to the most appropriate method to perform ETS. As in any other debate those surgeons who talk against the clamping method are claiming certain facts which are said without having any clinical experience performing the clamping method. So far clinical experience shows that the success rate as well as the recurrence rate is equal in both methods (Destructional Method or the Clamping Method)

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