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Endoscopic Thoracic Sympathectomy (ETS)

There are two surgical methods to treat excessive sweating. One is the “classic” method and the other is the “endoscopic” method. The classic method is open surgery and it is done through large incisions. The second method is ETS (endoscopic thoracic sympathectomy). ETS is a procedure aiming to decrease sweating in certain areas that have excessive sweating.

The endoscopic method which has become widespread to treat excessive sweating is a closed operation. Both of the operations are equally effective. ETS surgery through clipping can be done in any season, as long as the patient is in good health.

ETS Surgery Incision

ETS surgery through clipping solves problems such as over sweating on the face, hands, underarms and feet as well as blushing.

After the surgery, sweating stops in areas where the removed sympathetic nerves controlled sweating. For example T2 sympathetic chain, face; T2 – T3 sympathetic chains, hands; T3 – T4 sympathetic chains, underarms; etc. ETS surgery is not an operation to remedy entire body sweating.

ETS (Endoscopic Thoracic Sympathetic) clipping for hyperhidrosis gets its name from the technique and the location of the operation. ‘Thoracic’ is the name of an anatomic area and it comprises of the chest cavity with all the organs in it. The term ‘endoscopic’ in the name stands for the small camera used during the operation.

In this technique, the surgeon conducts the operation through 2 incisions 1 centimeter in length made in the underarm into the chest cavity to operate on the sympathetic chain with the help of an endoscopy camera. In this operation large incisions as in conventional surgeries are not necessary. Incisions are commonly 1 – 1.5 centimeters in length.

ETS Surgery

This is the reason why all the surgeries conducted with this technique are called closed surgeries.

Sympathectomy is the ascension of the sympathetic chain (nerve chain causing sweating) to the determined level.

To sum it up ETS surgery limits or prevents the neurotransmission which causes sweating by either surgically removing a part of the sympathetic nerve or by placing clips above and under the sympathetic nerve. The surgery is conducted from both sides of the chest.

ETS Surgery – Cutting versus clipping

ETS surgery is performed using two techniques, one with cutting and the other clipping the nerve. After details of both procedures are explained to the patient, it is up to the patient to decide whether clipping or cutting of the nerve will be the method of surgery. Success rate is similar in both techniques.

After ETS Surgery


Sweating slows down within ten minutes after the nerve us cliped or cut in the surgery, palms get dry and warm up. By the time patient wakes up excessive sweating has stopped.

Preparing for surgery;

  • Breathing and heart check up
  • History of the problem
  • Lab tests
  • Lung graph (Lung tomography if necessary)
  • Electrocardiograph (Cardiology consultation if necessary)
  • Internal medicine consultation
  • Setting a date for the surgery

Most patients (more than 95%) are discharged in the afternoon of the surgery or the next day. If the patient had open surgery they stay in the hospital for 3 – 5 days.

Following the Surgery

Compensatory sweating occurs in 50 – 80% of the patients after the surgery. Compensatory sweating is excessive sweating of certain other areas after the surgery such as chest, back or thighs but not areas that sweat excessively prior to the surgery.  If the nerve is cut, it is not possible to bring the patient back to their state prior to the surgery.

If the nerve is cliped, patient may be brought back to her initial state however success rate is low (10 – 20%). Even if the clip is removed since the tissue is damaged because of the clip the effects of the surgery will continue at an 80 – 90% rate.

ETS Surgery Success Rate

Success rates of clipping or cutting are equal and they are listed below;

  • Sweating of the face, blushing, 95 – 99%
  • Sweating of hands, 90 – 95%
  • Sweating of underarms, 95%
  • Sweating of feet, 50%


Compensatory sweating is excessive sweating that may occur following ETS surgery. It occurs in the back, chest area, stomach area and thighs.



  • Reconnecting te sympathtetic nerves that were cut or damaged during the initial ETS surgery.
  • Relieving th patient by reducing compensatory sweating.
  • Nerve regeneration usually occurs 2 months after the surgery.
  • Clinical results are observed and the patient feels relief 6 – 18 months after the surgery.

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