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Watch Video - What Areas Does Micro ETS Treat by Dr. Nielson
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Micro ETS - Minimally Invasive Endoscopic Thoracic Sympathectomy - Ganglion-Sparing, Less Traumatic Surgery Technique.

Micro Endoscopic Thoracic Sympathectomy
Micro ETS, treats with a high success rate,  Hyperhidrosis (face/head/scalp/neck, hands, underarms), Blushing/facial Hyperpyrexia, Raynaud's Syndrome) - cold fingers, causalgia (RSD), anxiety triggered "racing heart", and migraine headaches.

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, talking to others, called on in class, focused attention on an activity, etc) causing excess sweating of the hands, armpits, face, scalp, head, neck and sometimes feet.

Single Tiny Incision Micro ETS  

Today, the treatment of choice for severe Hyperhidrosis is ETS.  The efficacy is 99% for Micro ETS. Fortunately today, for patients afflicted with excessive sweating of the hands, face, head, scalp, neck, underarms, Raynaud's Disease, embarrassing blushing,/burning, Micro ETS can immediately improve these symptoms.   To effectively treat symptoms of the face/head such as Hyperpyrexia of the face/head and Blushing/burning Hyperpyrexia, the sympathetic nerve signals have to be stopped at the 2nd rib level, otherwise no improvement would be seen and symptoms might actually become more severe, since the T2 neural pathway would be left intact carrying more nerve signals to the head area.  Micro ETS has a high success rate in treating symptoms of 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 that is only 1/12th of an inch per underarm, Micro ETS can effectively treat, with immediate improvement, symptoms of Hyperhidrosis, Blushing/Hyperpyrexia, and Raynaud's of the fingers.

Benefits of "Micro Single Incision" ETS

micro ets incisions
  • Immediate improvement in the severe symptoms.
  • Effective for Blushing/burning, Hyperhidrosis of the face/scalp/neck, hands, axillae, Raynaud's of the fingers.
  • Single-Micro Incision technique (1/12th Inch Incision) “Ganglion sparing, less traumatic".
  • Lungs are NOT collapsed.
  • Dissection of the nerve not required to find it (No Horner's Syndrome-drooping upper eyelid)
  • No sutures required. 
  • Much less postop pain.
  • High success rate.
  • FDA approved instruments/equipment.
  • Same day surgery (discharged 1 to 2 hours after).
  • Not an experimental procedure. Latest technology applied to decades-proven invasive (open) sympathectomy.
  • Precise visual localization of the nerve without having to "dig it out from the chest wall tissue" to find it.  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; entering trough the back, entereing above the clavicles, a long incision between the ribs with rib resection, through 2 to 3 incisions per side. Dissection of the nerve from the inner chest wall tissue is NOT required to find it with Dr Nielson's Micro ETS technique.  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 least invasive to the tissues to treat severe hyperhidrosis involving the scalp, face, hands, and axillae, Blushing/burning of the face and Raynaud's of the hands. It is highly effective in improving facial blushing burning that impairs one's ability to focus and think about the "task at hand".

hyperhidrosis incisions  

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.Without distubing the tissue of the inner chest wall (no dissection or digging out of the nerve), identification of the sympathetic nerve and any Kuntz nerve branches is performed by Dr Nielson. Signals from the second thoracic ganglion level are blocked from traveling past the 2nd rib level on their way to the face/head, hands, by cutting the sympathetic nerve precisely where it crosses the second rib heads using the tips of the 2 mm micro endoscissors. The divided ends are cauterized with the tips of the scissors using a low current to minimize the chance of nerve reconnections. For axillary hyperhidrosis two ganglia levels are precisely blocked, by cutting the sympathetic nerve and any Kuntz nerve Images of Micro ETS branches where 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, bleeding and post-op pain.  Horner's Syndrome doesn't happen since the nerve isn't dissected out to find it.

A topical skin glue 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 with Dr Nielson. 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.

Watch Video - Hand Sweat Treated for Young Female Patient
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After the sympathetic nerve has been cut at the second rib level in the operating room, the skin of the hands/fingers, face, scalp and neck becomes dry. This change occurs in the operating room 30 to 60 seconds after the nerve is divided. Some patients don't experience cs (compensatory sweating), but most do experience mild to moderate cs and 10% of my patients develop severe cs on the lower back and abdomen. Talk to your doctor about compensatory sweating, Horner's Syndrome, efficacy especially for treating the face/head area for Hyperhidrosis and/or Blushiing, before participating in any surgical program so that you can determine what is best for you and your condition.

Patients report that following surgery, scalp and facial blushing subside and cardiac reactions to stress (increased heart rate) is moderated and improved dramatically. Stage fright response is substantially reduced and patients feel more calm and can "be themselves".  Hyperhidrosis of the feet even improves in some cases, through an indirect mechanism, since the nervef that goes to the feet is in the abdomen and is therefore not touched. Long term improvement in sweating of the hands, face, scalp, neck and improvment in Blushing/burning of the face is seen.  In some patients the ability of the nerve to regenerate as early as one year and as late as ten years after sympathectomy, is seen in 5% of patients. Some patients report a return of slight sweating during exertion one or more years after sympathectomy and often describe it as “normal” sweating. Due to anatomical differences of nerve pathways in some patients, intact nerve fibers may remain following sympathectomy which could lead to persistent symptoms.

Immediate post operative skin dryness, improvement in blushing, warming of fingers. High success rate for:

  • Palmar Hyperhidrosis
  • Scalp, Face, Neck sweating
  • Blushing & facial Hyperpyrexia
  • Raynaud's of the fingers.

Dr. Nielson’s Micro ETS technique is less invasive because he uses only one incision that is tiny, only 1/12th of an inch, doesn't collapse the lungs and doesn't dig the nerve out from the chest wall lining to find the nerve.  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. ETS procedures differ in technique and invasiveness, therefore efficacy, side effects, complications and recovery time may similary vary.

Known Side Effects
Patients should be aware that compensatory sweating can and does occur.

Compensatory sweating is experienced as excessive sweating on the back, thighs, stomach, axillae, groin and/or lower legs and may range from mild to severe. Reported incidence of developing compensatory sweating in world literature range between 50% to 90% of all patients undergoing the ETS procedure. Of this group, it has been reported that about 5% - 10% of these patients experience severe compensatory sweating. Severe compensatory sweating, or severe compensatory hyperhidrosis, can be very troublesome, especially when it soaks through clothing. This can be more problematic in hot humid climates and can become more of a problem than the original problem treated.

The tolerance of compensatory sweating is patient dependent. Some patients tolerate severe sweating while others do not tolerate even mild compensatory sweating. There are medications that may help lessen the severity of compensatory sweating post operatively.

Overweight patients may experience more compensatory sweating and those who live in hot, humid climates may find it less tolerable. Compensatory sweating is the most common side effect reported by patients regardless of which surgeon is performing ETS.

Gustatory Sweating, which occurs while eating or smelling certain foods, can develop post operatively in about 10 to 20% of the patients and is associated with sweating of the upper lip and/or forehead.

Phantom sweating occurs in some patients after ETS surgery (feeling the sensations of sweating but not actually sweating) and typically resolves in 1 to 3 weeks after surgery.

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  • Prior thoracotomy - relative contraindication.
  • Coagulopathy, Untreated Hyperthyroidism.
  • Severe cardio-circulatory or pulmonary insufficiency.
  • Severe pleural diseases (empyema, pleuritis).

Please contact us for more information on Hyperhidrosis, Blushing/Hyperpyrexia, Raynaud's: Call 210-490-7464   Email info@dhnmd.com or Submit a questionnaire.

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