Although many patients and doctors alike are cautious about this surgical procedure, sympathectomy has proven to be most effective in treating palmar hyperhidrosis. Endoscopic thoracic sympathectomy or ETS works by interrupting nerve impulses in the sympathetic nerves located in the chest (thoracic) cavity. These nerves have 12 branches, numbered 1-12, which have specific effects on the activity of sweat glands in different parts of the body. Sympathectomy can be performed in the following ways:
● Cutting: Sympathetic nerves are cut with surgical scissors or through electrocautery. Once this is done, the nerves may no longer be reconstructed, in the event that the nerves will be needed in the future.
● Clipping or clamping: In this procedure, the end goal of interrupting the impulses in the concerned nerves is achieved by applying a titanium clip or clamp on the nerve. No nerve cells, fibers, or ganglions are said to be destroyed, thereby (theoretically) allowing the reconstruction of the nerve when needed.
● Resecting: Preferred by most surgeons, excising a segment of the concerned thoracic nerve does the job of interrupting impulses from reaching the sweat glands. However, reconstructing the surgically-damaged nerve will prove difficult when the need arises.
Aside from difficulty in nerve reconstruction, sympathectomy results in compensatory sweating or excessive sweating in the lower chest, abdomen, back, thighs, and legs. As the term compensatory infers, this side effect is the body’s way of releasing sweat in the absence of outlets which no longer function. Patients who undergo clamping are said to experience the least compensatory sweating while those who have a big area of the nerve excised or completely cut experience it the most.