Endoscopic
Thoracic Sympathectomy (Micro ETS) - Ganglion-Sparing, Less Traumatic
Surgery Technique.
Endoscopic Thoracic Sympathectomy
Micro ETS surgery is a treatment option
for Hyperhidrosis
(facial, head, hands, underarms),
facial blushing, vascular disorders (Raynaud's Syndrome), causalgia
(RSD), and migraine headaches.
Introduction
Hyperhidrosis is present in
0.6 to 1% of the population. The sympathetic nervous system is
overactive in these people at inappropriate times (low stress conditions,
sitting quietly, cool surroundings, etc) causing excess sweating
of the hands, armpits, face, scalp, and sometimes feet.
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Today, the treatment
of choice for severe hyperhidrosis is ETS. Fortunately today,
for patients afflicted with excessive sweating of the hands,
face, underarms, feet, Raynaud's Disease, embarrassing blushing,
or Causalgia, there are a few surgeons around the world who are
experienced with this minimally invasive technique. Many
individuals can now be treated surgically with improvement of
symptoms from hyperactive sympathetic nerves with minimal cost
and morbidity, rather than just receiving repeated life-long
treatments which are palliative at best.
Micro ETS was developed by Dr. Nielson by applying
new state-of-the-art technology to invasive thoracic sympathectomy
of the past which has been done for decades. Now, through a single-incision
ETS, what was once considered to be extremely invasive surgery
reserved only for the most severe cases (severe Raynaud's or Causalgia
for example), is available to and highly curative for the many
individuals today who are plagued by symptoms of over-active sympathetic
nerves.
Benefits of "Micro Single Incision" ETS
- ETS surgery results are curative immediately.
- Patients
leave the operating room with dry scalp, face, hands, armpits.
- Single-Micro Incision technique
(1/12th Inch Incision) “Ganglion
sparing, less traumatic".
- No sutures required.
- Much
less postop pain.
- High success rate (99.9% for hyperhidrosis
of the palms).
- FDA
approved instruments/equipment.
- Same day surgery (discharged
the same day means lower cost).
- Not an experimental procedure.
Latest technology applied to decades-proven invasive (open)
sympathectomy.
- Precise visual localization and
transection of the ganglia of interest. Dr. Nielson has
found over the years that by sparing the ganglia, side effects
may be less likely.
Less morbidity than by other approaches such as; Through
the back. Above the clavicles. A long incision with rib resection.
Through 3 or 4 incisions. Rapid return to full functional status
usually two to three days for school/work and one week for full
physical activities. Improved occupational/professional and social
interactions. Sympathetic ganglia are located along both sides
of the spine. The removal or destruction of some of these ganglia
has been done for decades to treat micro circulation disorders
of the hands and feet and hyperhidrosis. Today, Micro ETS is the
method of choice to treat severe hyperhidrosis involving the scalp,
face, hands, and axillae. Also, it is effective in improving facial
blushing which may cause social embarrassment.
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Technique
Micro ETS is done in an ambulatory
surgical center. Both sides are done at the same time. General
anesthesia is required. The lungs are NOT collapsed. Only
one micro incision (1/12th inch in length) is made along the outer
aspect of the pectoralis major muscle in the axilla (arm pit) in
the third intercostal space. A 1/12th inch endoscope is inserted
through the Micro chest incision into the thoracic cavity.Identification
of the sympathetic nerve and any Kuntz nerve branches is done.
One thoracic ganglion level is isolated by cutting the sympathetic
nerve precisely as it crosses the second rib. The divided ends
are cauterized using a low current to minimize nerve reconnections.
For axillary hyperhidrosis two ganglia levels are precisely isolated
by cutting the sympathetic nerve and any Kuntz nerve  branches
as they cross the second, third and, fourth ribs for a T2-T3 sympathectomy.
The nerves and ganglia are not removed with this technique. The
ganglia are left attached to the spinal cord with preservation
of the interganglionic connections. This helps to lessen compensatory
sweating and post-op pain.
A topical
skin adhesive is used to close the tiny single incision. Upon completion
of the right side, the left side is then done in similar fashion.
A chest X-ray is taken and the patient discharged a few hours later
with a follow-up exam in the morning. The patient then returns
home.
Normal activities can resume a few days later and
full physical activities in one to two weeks. Whether unilateral
or bilateral sympathectomy is performed depends on the patient's
and surgeon's preoperative plan. Dr. Nielson usually
performs bilateral sympathectomies at the same sitting.
Results
Palmar hyperhidrosis is successful
in 99.9% of patients.Success
is immediate and the patients awaken in the operating room with
a dry and warm hand, scalp, face, and axillae. Scalp and Facial
blushing subsides and cardiac reactions to stress (increased heart
rate) is moderated. Stage fright is substantially reduced. Hyperhidrosis
of the feet even improves in many cases, but this effect is less
predictable.
Success rates:
99.9% for palmar hyperhidrosis
98% for scalp and facial sweating
85%-95% for facial blushing & facial hyperpyrexia
75%-90% for axillary sweating
60% for RSD
85%-90% improvement rate for Raynaud's (condition recurs over
time)
Complications
Serious
Complications are unusual.Possible
perforation of breast implants if present. Sensitive Pleurae (chest
lining sensitivity) limiting exercise. Horners Syndrome occurrence
rate 0.3%. Heat intolerance. Pneumothorax (collapsed lung), Bleeding,
Postop Neuralgia and parasthesias are uncommon. Possible hair loss.
Bradycardia (slow heart rate) possibly requiring a pacemaker. Subcutaneous
emphysema. Possible conversion to open thoracotomy. Possible recurrence
of symptoms. Possible necessity for re-do operations. Treatment
failure can occur if Kuntz nerves are
present and are not cut. Death.
Possible Side
Effects
Dr. Nielson’s Micro ETS technique
is less invasive because the T2 ganglion is not disturbed in
any way. He has found over the years that by sparing
the ganglia, side effects may be less likely. Compensatory
sweating is the most common side effect reported by many patients.
The tolerance of compensatory sweating is patient dependent. Some
tolerate severe sweating while others do not tolerate even mild
compensatory sweating. It is difficult to predict pre-operatively.
Some medications may help lessen the severity of compensatory sweating
post operatively. Overweight patients may experience more compensatory
sweating.
Phantom sweating, where the patient feels the sensations of sweating
but is not actually sweating, typically resolves in 1 to 3 weeks
after surgery.
Significant reduction in sweating of the upper chest/back,
hands, face/head.
Heat Intolerance. Gustatory sweating (increased sweating while
smelling or eating) occurs in some patients.
Contraindications
Please contact
us for more information on hyperhidrosis by calling 1-877-837-9379
toll free or submit
a questionnaire.
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