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Endoscopic Thoracic Sympathectomy (ETS) is a medical procedure where certain sympathetic nerve ganglia are burned, cut or clamped. ETS is used to treat hyperhidrosis, facial blushing and social phobia. By far the most common complaint treated with ETS is palmar hyperhidrosis, or
"sweaty palms".
History
Open sympathectomys have been performed for over 50 years. It was a difficult operation to perform and took a long time for the patient to heal. With the development of endoscopic surgery ETS has become a reality. ETS is minimally invasive procedure done under general anesthesia and normally performed on an outpatient basis.
Overview
ETS surgery works by either permanently destroying healthy nerve tissue by burning or cutting, or temporarily if the nerve tissue was clamped. However, reversal of the clamping procedure has a short window, and may be incomplete. ETS could, by interrupting the nerve signals, alter the body's fight-or-flight response.
ETS can alter many bodily functions, including sweating, heart rate, heart stroke volume, blood pressure, thyroid, baroreflex, lung volume, pupil dilation, skin temperature, goose bumps and other aspects of the autonomic nervous system. It can diminish the body's physical reaction to exercise and/or strong emotion. In rare cases sexual function or digestion may be modified as well.
Results
A more or less typical result of ETS surgery would be: Total anhidrosis (inability to sweat) from the nipple-line up, excessive sweating from the nipple-line down (known as "compensatory hyperhidrosis" or "reflex hyperhidrosis"), heat intolerance, very dry hands requiring hand lotion, and a 10% reduction in resting heart rate. Exact results of ETS are impossible to predict, because of considerable anatomic variations in sympathetic nerve function from one patient to the next, and also because of variations in surgical technique.
Studies by ETS surgeons have shown a satisfaction rate around 85-95% with at least 2% regretting the surgery [1] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14673674)
[2] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11788259)
[3] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9640370). At least one independent study shows a dissatisfaction rate much higher [4] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15276490). Most patients report various complications as a result of the surgery.
Risks and controversy
There is tremendous controversy surrounding ETS. While prestigious medical boards such as the Society of Thoracic Surgeons fully support it, the National Institutes of Health considers ETS to be a "nerurocardiologic disorder", and NIH studies ETS patients as part of their protocol for autonomic failure. There is much disagreement among ETS surgeons about the best surgical method, opitimal location for nerve destruction, and as to the nature and extent of the consequent side effects. The internet now features many websites run by surgeons extolling the benefits of ETS backed by happy patient testimonials. However, there are also many websites run by disabled ETS victims who complain of severe complications and lack of adequate informed consent. Several online discussion forums are dedicated to the subject of ETS surgery, where both positive and negative patient testimonials abound.
External links
- dmoz.org (http://dmoz.org/Health/Conditions_and_Diseases/Skin_Disorders/Hyperhidrosis/Clinics/) - Hyperhidrosis clinics section of the open directory project
- ESFB Channel (http://www.esfbchannel.com) - Information about excessive sweating, facial blushing, rosacea and social phobia
- Truth About ETS (http://www.truthaboutets.com) - ETS education, information and loud protest created by an angry disabled ETS victim
- ETS & Reversals (http://p069.ezboard.com/betsandreversals) - Discussion about ETS, the side effects, the surgeons, and the ongoing search for a working reversal
- Radisson Group (http://www.noetsuk.com) - Demanding radical and far reaching changes to the ETS industry
- FfSo (http://home.swipnet.se/sympatiska/index3.htm) - People disabled by sympathectomies
- P.A.S.S. (http://www.ets-sideeffects.netfirms.com/) - Patients Against Sympathetic Surgery
- Presentations at the 4th International Symposium on Sympathetic Surgery (http://www.angelfire.com/ab/ets/201.htm#_Hlt521158972)
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