For excessive hand sweating the leading surgical approach currently available is a procedure called Endoscopic Thoracic Sympathectomy (ETS). This technique has been improved and developed since about 1990. Not only has the surgical technique improved but also our physiological understanding with regard to the procedure. For years the sympathetic segment at the T2 level was the hallmark of the surgical treatment which years ago was done through the open method via the neck, armpits or the back. Those were very aggressive and extensive surgical procedures and they stayed somewhat unpopular. The endoscopic approach in which the operations are carried out through very small incisions with a very rapid recovery time it became much more popular. The next improvement was the lowering of the segment to the T2 level to the T3-T4-T5. Lowering the level from the T2 to the lower segments proved to be beneficial with regard to the number of patients with severe compensatory sweating which came down. With this particular method a segment of the thoracic sympathetic chain is eliminated either with clamps, destroyed or excised. The use of clamps offers the same rate of success however with a possibility of reversal. Regardless of the type of procedure chosen, a thorough discussion between the patient and their surgeon is very important.
ETS has a very high success rate for alleviating excessive hand sweating. The success rate ranges from 98% to 99%. The operation is done on an outpatient basis with a quick return to a normal way of life. Obviously like in any other surgical procedure side effects are inevitable and those should be discussed the surgeon in great detail. The most common side effect is compensatory sweating which is sweat that occurs on the lower legs, thighs, abdomen and back. For most of the patients the compensatory sweating is preferred much more than the original condition of excessive hand sweating. There is the possibility for other rare side effects which should be discussed with the performing surgeon.
The surgcial procedure is known medically as Endoscopic Thoracic Sympathectomy (ETS). This procedure is specific to excessive hand sweating. The operation is carried out on an outpatient basis (patients go home same day) allowing the patient to resume activity and normal life style within a very short time (2 to 3 days). The lungs are not collapsed because we use single lumen intubation. Basically there two relatively small incisions made on each side of the chest cavity. Cosmetically the resulting small scars are very small (8 to 9mm). The usage of clamps also gives any outside reviewer the possibility of verifying the exact location where the sympathectomy was done. Also there is a theory by not using any electric power on the sympathetic trunk itself prevents damage that can be caused by the usage of electrical current.
Endoscopic thoracic sympathectomy should be considered as an effective and proven option for the treatment of excessive hand sweating. It should be tried only after failed conservative measures have been tried by the patient. The patient should have a thorough understanding of the procedure and its effect before a final decision is made.
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