ETS Surgery for

Endoscopic thoracic sympathectomy is a surgical procedure to decrease sweat production by interrupting the nerves that cause excessive sweating. This procedure can be highly effective and is ideally suited for patients who suffer palm, underarm and facial sweating, or other forms of sweating that is resistant to other methods of treatment.

  • This is a highly specialised procedure conducted by a vascular surgeon
  • Success rate for reducing or eliminating excess sweat production is very high, and can be expected to exceed 90%.
  • The procedure involves cutting the sympathetic nerves behind the chest wall that supply the sweat glands in the arm and hand
  • In addition to reducing sweating in the palm, armpit and face, ETS can also reduce excessive flushing and blushing of the face
  • Patients should always consider and try non-surgical treatments for excessive sweating prior to undergoing ETS
  • The effects of ETS should be considered a permanent result with recurrence rates extremely low



This is a surgical procedure conducted by a vascular surgeon in hospital under general anaesthesia. It results in the interruption of nerve signals from the spinal column to the eccrine (sweat) glands. This in turn decreases or eliminates the signal to produce sweat. Once performed, the procedure and effects should be considered permanent.

This form of sweat treatment is very effective. The results are immediate – when the patient wakes from the anaesthetic, the palms will be completely dry and warm. The success rate for alleviating palmar sweating exceeds 90%, and for the reduction of armpit sweating is over 80% effective.

It should be stressed that medical therapy is recommended prior to considering surgical intervention. The success rate for treating facial sweating and blushing is approximately 70-80%.

ETS can be employed to treat severe sweating of the hands, face, scalp and armpits.

Sweating of the face and scalp can be so severe that sweat can profusely flow, despite comfortable environmental temperatures. In some cases this type of sweating can also be associated with flushing and blushing. This location of sweating is often the most debilitating and can be difficult to treat without surgery. Sweat stopping treatments injections can be used in certain areas such as the forehead and scalp, but if sweating in other areas of the face, this treatment is not as useful. In this location, patients should discuss the procedure of ETS with a Specialist Surgeon.

Sweating of the hands can also be treated by ETS. In general the Sweat Free Clinic encourages patients to try non-surgical methods of treatment for sweaty palms prior to the consideration of ETS. Treatments such as Driclor, Iontophoresis and sweat stopping treatments should be considered for excessive sweating in these locations first.

Armpit sweating can also be treated with ETS, with success rates of up to 85%. ETS for excessive sweating in this area has largely been replaced by sweat stopping treatments and or Driclor.

ETS is performed in hospital in an operating theatre by a specialist Vascular Surgeon. The procedure requires a general anaesthesia conducted by an anaesthetist.

ETS is a surgical procedure performed under general anaesthesia by very highly trained specialists. Two very small incisions are placed underneath the armpit, in between your ribs to gain access to the chest cavity. One lung is then collapsed while the other is kept inflated during the case. Using small a small camera and instruments inserted through the tiny cuts, the surgeon will identify the sympathetic chain within your chest wall. This chain is a collection of nerves which travel down from the brain and eventually leave the chest to supply the sweat glands in the arm or face. The bundle of nerve fibres is then divided with a special scalpel. Once everything is checked carefully, a small drain tube is inserted and the lung is then re-inflated. Usually the procedure is then repeated on the other side to treat both arms in the same operation.

Like any surgical procedure, ETS carries some risk. As an operation performed under general anaesthesia, there is a minor risk of bleeding, infection, lung problems and medication reactions. To operate on the nerves at the back of the chest, it is imperative that the lung on that side be deflated during the case. A special tube is used to enable the other lung to remain inflated. Once the procedure is complete, the deflated lung is re-expanded under vision. Sometimes a small amount of air can remain outside of the re-inflated lung. This is called a pneumothorax. The remaining air will be reabsorbed by the body over several days and does not cause any concerns. A chest x-ray will be performed after the operation to ensure the lung is completely re-expanded.

It is very well known that 20-50% of patients who undergo this procedure will develop sweating elsewhere. This is known as compensatory hyperhidrosis and is unfortunately unavoidable. This is the most common side effect of ETS. Whilst the operation will reduce sweating in the targeted area (such as sweaty palms, sweaty face), you may experience some degree of ‘compensation’ in a different area of the body as not all of the nerve impulses for excessive sweating can be eliminated. Areas such as the legs, scalp, abdomen, arms, thighs or buttocks may compensate for the diminished sweat production in the arm, palms or face. The areas involved and chance of this side effect is unpredictable. In most cases, the effects are mild and well tolerated. Most patients who develop compensatory hyperhidrosis find it much less problematic than the sweating they originally had the surgery for.

Horner’s syndrome is a constellation of symptoms from the interruption of the T1 nerve ganglion. This causes eyelid drooping and pupil diameter changes in the eye. The ETS procedure requires only T3 and sometimes T2 ganglion interruption, but not T1. This complication is therefore extremely rare. If it occurs, most cases resolve over 6 months but some may be permanent.

For more details in regards to the success, failures and side effects of this surgery, discuss this procedure in more detail with your surgeon.

These days, patients have a number of non- surgical options for excess sweating. Options will depend on the areas involved. Treatments for sweating include antiperspirants, sweat stopping treatments injections, iontophoresis, and specially compounded creams and solutions.

We suggest patients trial less invasive methods prior to the consideration of major surgery.

- All medical treatment options have been tried or are considered inappropriate for the distribution of excessive sweating.

- The risks of the procedure have been extensively considered.

- The procedure details have been thoroughly discussed with your surgeon and the conclusion reached that the potential benefits outweigh any reasonable risk.

There are no secondary medical causes for excessive sweating such as over-active thyroid or hormone-secreting lesions.

Dr Andrew Cartmill

Vascular and Endovascular Surgeon

Excessive sweating can be a very debilitating problem for many people, and it often interferes with work duties and daily activities. Many of my patients find the condition extremely embarrassing, and are concerned about odours, shaking hands and wet stains on their clothing. Indeed it can pose significant safety concerns when driving or operating machinery.

There are many treatment options for excessive sweating, and with the help of a medical team-based approach, a methodical progression through the treatment regimens available is the ideal way to tackle this problem. My expertise lies with performing minimally-invasive thoracic sympathectomy surgery. This procedure is safe, and extremely effective. The results are both dramatic and instantaneous, and should be considered permanent. My patients are always shocked to wake from the anaesthetic with completely dry, warm hands that for most of their adolescent and adult life, have been moist and clammy.

Like any surgical procedure, patients need to be well-informed of the risks and benefits of surgery, with a good grasp of the expectations after the procedure. I always ensure that these discussions are very comprehensive.

After trialling other medical therapies for hyperhidrosis without success, thoracoscopic sympathectomy is an extremely effective treatment solution which has been used successfully for decades. It is especially suited to excessive palm and facial sweating. When performed by a trained specialist surgeon, it is a well-tolerated procedure with impressive success rates for which most patients are very grateful to have undergone.