Endoscopic Thoracic Sympathectomy

Endoscopic thoracic sympathectomy (ETS) is a controversial surgical procedure where certain portions of the sympathetic nerve trunk are destroyed. ETS is used to treat hyperhidrosis, facial blushing, Raynaud's disease and reflex sympathetic dystrophy. By far the most common complaint treated with ETS is palmar hyperhidrosis, or 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.

In addition to the normal risks of surgery, such as bleeding and post-operative infection, sympathectomy has several specific risks, such as irreparable adverse changes in how nerves function.