Endoscopic thoracic sympathectomy - Cure and causes of ETS
Hyperhidrosis
or excessive sweating is believed to be secondary to over activity
of the sympathetic nerves located in the chest cavity. Surgical
treatment of hyperhidrosis involves interrupting the sympathetic
nerves.
These
nerves have 12 segments in the thoracic cavity from T1 to T12. This
procedure is called endoscopic thoracic sympathectomy. In its different
variations it is referred to as ETS, ETS-C,
or ESB.
Sympathectomy is performed through small keyhole incisions in the
underarm area under general anesthesia. The sympathetic nerves are
then found in the thoracic cavity and are either cut, clamped or
resected. Details of this surgery are well explained at www.endsweat.com
Sympathectomy can be achieved by various methods:
Sympathectomy
by clamping or clipping (ETS-C / ESB)
In this method the sympathetic nerves are interrupted but not physically
cut. This is accomplished by applying a titanium clip/clamp to the
nerve. The pressure from the clamp interrupts the nerve signals
through the sympathetic nerves. The sympathetic ganglia are not
destroyed. The advantage of the method is the theoretical possibility
of reconstructing the nerves in the future by removing the clamps.
Sympathectomy
by cutting
In this method the sympathetic nerves are physically cut with scissors
or electrocautery. The disadvantage of this method is that it is
extremely difficult to reconstruct the sympathetic nerves in the
future.
Sympathectomy
by resecting the sympathetic nerves
Some surgeons prefer the removal of a segment of the sympathetic
nerves. This method is effective in treating various forms of hyperhidrosis.
However again it is extremely to reconstruct the sympathetic chain
after this procedure.
The extent of
sympathectomy
The extent or level of the endoscopic sympathetic blockade, ESB,
varies according to the type of hyperhidrosis or facial blushing:
Condition
Level
of ESB
Facial Blushing
T2
Facial Sweating
T2 or T3
Hand Sweating
T3 or T4
Underarm
Sweating
T4 or T5
It is believed that by
limiting the level of ESB to a specific segment of the sympathetic
chain, compensatory sweating, the
most common side effects of surgery, can be reduced.
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