What is ETS? Endoscopic Thoracic Sympathectomy


What is ETS - Endoscopic Thoracic SympathectomySympathectomy is the term applied to the division, excision or ablation of the sympathetic nerves. The sweat glands responsible for perspiration are supplied by the sympathetic nerves and if these nerves are ablated or destroyed, the sweat glands will cease to function.

The sweat glands of the hands, armpits, face and scalp are supplied by sympathetic nerves that originate from within the chest (or thorax). These nerves can be identified clearly through a telescope (thoracoscope) in the chest. Hence, a thoracoscopic sympathectomy refers to ablation of the sympathetic nerves in the chest via a telescope using minimally invasive techniques.

ETS is performed under general anaesthesia in hospital.

Once under anaesthetic two (5mm diameter) ports are inserted into the chest between the ribs in the armpit. Breathing of the lung is temporarily suspended allowing the sympathetic nerve to be accurately identified. With a clear, uninterrupted view of the sympathetic nerve the relevant section or ganglia (never cell bodies) is ablated.

There is no danger with the procedure, as normal blood oxygen levels are maintained throughout. A special tube allows each lung to be "breathed" separately.

Ablation or destruction of the sympathetic nerve is accomplished by diathermy or electro-cautery of the relevant section of the chain.

Once this has been accomplished, the lung is fully re-inflated and normal “breathing” restored on that side. The ports are removed and the small incisions closed with a solitary nylon stitch and water-proof dressing applied.

Post Operative CareDue to the minimally invasive nature of Endoscopic Thoracic Sympathectomy recovery is usually rapid. There might be some initial chest discomfort but this is readily brought under control with pain relief such as Morphine. Most patients are reasonably comfortable within 6 hours of the procedure, requiring simple pain relief for a period of up to 48 hours.

Immediately following the procedure, a X-ray of the chest is performed in the recovery room in all cases to ensure there is no evidence of air around the lung (pneumothorax).

After one hour in the recovery room, you will return to your ward where you will remain until the following morning. Routine observations are undertaken by the nursing staff. Pain relief is available to maintain comfort. Normal diet is resumed within 4 hours of the operation.
Article by
Melbourne Vascular Surgeon