Endoscopic Thoracic Sympathectomy (ETS)

If your hyperhidrosis is excessive and not responding to non-surgical treatments, you may be a candidate for endoscopic thoracic sympathectomy (ETS).

This treatment is for severe cases of palmar hyperhidrosis (sweaty palms) and has also been used for abnormal sweating of the axillae (armpits), feet and face. A minimally invasive surgical procedure, this surgery has a high success rate in properly selected cases.

During this procedure, your surgeons will make two very small incisions, about a half-inch each. Your surgeons will insert an endoscope in order to locate the nerves that will be worked on, and then use a surgical tool to clamp the nerves that are causing you to sweat.

After the surgery, you are usually discharged on the same day, and you can resume work and regular social activities within a couple of days. Recurrence of excessive sweating following the procedure is uncommon. If this option is right for you, you can look forward to many years of freedom from this distressing condition.

Who Does Best With Surgery?

The best candidates for endoscopic transthoracic sympathectomy (ETS) surgery are patients with hyperhidrosis of the hands. Such patients often also have some hyperhidrosis of the axillae and feet. While ETS surgery is very successful in stopping the sweating in the hands, the effect on the axillary and foot sweating is less predictable.

Who Do We Not Offer Surgery To?

We do not usually offer surgery to patients whose sweating is mostly in areas other than the hands. This is particularly true for patients who have sweating all over the body. Patients with hyperhidrosis of the feet, groin, chest or abdomen are not considered to be candidates for this surgery.

What Are the Side Effects of Surgery?

The vast majority of properly selected patients do very well and have minimal to no side effects. However, the side effects that one needs to be aware of are:

  • Compensatory hyperhidrosis: This is the term used to describe excessive sweating that could possibly develop after surgery. It affects the body below the nipples. In patients who have whole body sweating to begin with, this could be very severe and such patients are therefore not offered surgery. In patients with palmar hyperhidrosis, a small amount of compensatory sweating could develop after surgery, but it is rarely significant and these patients are generally more than happy with the trade-off.
  • Horner’s syndrome: A droopy eyelid with a small pupil and loss of sweating around the eye can rarely develop after surgery. At the level that we operate on, this is highly unlikely.
  • Recurrent sweating: Once the problem has been surgically corrected, it almost never recurs. If it does, it may be possible fix the problem by re-operating and clipping the sympathetic chain again.
  • Surgical complications: Almost all patients do well and go home the same day. However, it is possible to develop a pneumothorax (air trapped in the chest), chest wall pain, infection and injury to the major blood vessels or the heart. These are very rare occurrences in experienced hands.

Long-Term Outcomes of Surgery

The vast majority of properly selected patients have an excellent result, come in for one or two follow up visits, are delighted with their results and get on with their lives.


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Hyperhidrosis Center

The Hyperhidrosis Center is dedicated to world-class diagnosis and treatment of neurological diseases and disorders.