Endoscopic thoracic sympathectomy (ETS) is a surgical procedure in which a portion of the sympathetic nerve trunk in the thoracic region is destroyed. ETS is used to treat focal hyperhidrosis, facial blushing, Raynaud's disease and reflex sympathetic dystrophy. By far the most common complaint treated with ETS is palmar hyperhidrosis, colloquially known as "sweaty palms".
Sympathectomy physically destroys relevant nerves anywhere in either of the two sympathetic trunks, which are long chains of nerve ganglia located bilaterally along the vertebral column (situated to reduce the potential for injury) responsible for various important aspects of the peripheral nervous system (PNS). Each nerve trunk is broadly divided into three regions: cervical (neck), thoracic (chest), and lumbar (lower back). The most common area targeted in sympathectomy is the upper thoracic region, that part of the sympathetic chain lying between the first and fifth thoracic vertebrae.
ETS involves dissection of the main Sympathetic trunk in the upper thoracic region of the sympathetic nervous system, thus irreparably disrupting neural messages that ordinarily would travel to many different organs, glands and muscles. It is via those nerves of the autonomic nervous system that the brain is able to make adjustments in the body in response to changing conditions in the environment, fluctuating emotional states, level of exercise, and other factors to maintain the body's homeostasis.
Because these nerves also regulate conditions like excessive blushing or sweating, which the procedure is designed to eliminate, the normative functions these physiological mechanisms perform will be disabled or significantly impaired by sympathectomy.
There is much disagreement among ETS surgeons about the best surgical method, optimal location for nerve dissection, and the nature and extent of the consequent primary effects and side effects. When performed endoscopically as is usually the case, the surgeon penetrates the chest cavity making multiple incisions about the diameter of a straw between ribs. This allows the surgeon to insert the video camera (endoscope) in one hole and a surgical instrument in another. The operation is accomplished by dissecting the nerve tissue of the main sympathetic chain.
Another technique, the clamping method, also referred to as 'endoscopic sympathetic blockade' (ESB) employs titanium clamps around the nerve tissue, and was developed as an alternative to older methods in an unsuccessful attempt to make the procedure reversible. Technical reversal of the clamping procedure must be performed within a short time after clamping (estimated at a few days or weeks at most), and a recovery, evidence indicates, will not be complete.
Care managers are standing by to answer your calls and find an affordable surgery center near you. Call now or select the Contact Us button below.