Conquer your Hyperhidrosis or Facial Blushing – see the trusted experts for the solution at North Western Vascular - Call 1800 793 289

Melbourne's Leading ETS surgeon


Mr Roger Bell at North Western Vascular specialises in performing ETS surgery. ETS is performed in a private hospital with overnight stay. surgery offers immediate and permanent relief from hyperhidrosis or Facial Blushing and in many cases, can be a new beggining for sufferers.

What is ETS - Endoscopic Thoracic Sympathectomy

1456053733415Sympathectomy is the term applied to the division, excision or ablation of the sympathetic nerves. The sweat glands responsible for perspiration are supplied by the sympathetic nerves, and if these nerves are ablated or destroyed, the sweat glands will cease to function.

The sweat glands in the hands, armpits, face and scalp are supplied by sympathetic nerves that originate from within the chest or thorax. The nerves can be identified clearly through a telescope in the chest. Hence, a thoracoscopic sympathectomy refers to ablation of the sympathetic nerves in the chest via a telescope using minimally invasive techniques.

WETS surgery is performed under general anaesthesia in the hospital. Once under anaesthetic, two 5mm diameter ports are inserted into the chest between the ribs in the armpit. Breathing of the lung is temporarily suspended allowing the sympathetic nerve to be accurately identified. With a clear, uninterrupted view of the sympathetic nerve, the relevant section or ganglia is ablated.

There is no danger with the procedure, as normal blood oxygen levels are continually maintained. A special tube allows each lung to be "breathed" separately, and ablation or destruction of the sympathetic nerve is accomplished by diathermy or electrocautery of the relevant section of the chain.

Once this has been accomplished, the lung is fully re-inflated and normal breathing restored on that side. The ports are removed and the small incisions closed with a solitary nylon stitch and a water-proof dressing is applied.

1456053759862 Please click link to see an abridged video of the ETS surgery procedure. WARNING : This video is from an operation performed by Mr Roger Bell. It is a surgical process and may offend some viewers.

Post-operative care

Due to the minimally invasive nature of ETS surgery, recovery is usually rapid. There might be some initial chest discomfort, but this is readily brought under control with pain relief such as morphine. Most patients are reasonably comfortable within six hours of the procedure, requiring simple pain relief for up to 48 hours.

Immediately following the procedure, an X-ray of the chest is performed in the recovery room to ensure there is no evidence of air around the lung (pneumothorax). After one hour in the recovery room, you will return to your ward where you will remain until the following morning.

Routine observations are undertaken by the nursing staff at our practices in Melbourne. Pain relief is available to maintain comfort, and a normal diet is resumed within four hours of the operation.

Potential complications of ETS surgery

As with all surgical procedures, individual reactions to the operation will vary. Our aim at North Western Vascular Surgery is to inform you of all the complications that may arise, even though the majority of patients do not experience them.

Rebound hyperhidrosis involves a slight increase in sweating in areas of the body not affected by the sympathectomy and frequently occurs in as many as 30 - 40% of patients. Some studies suggest that rebound hyperhidrosis is higher, but for most patients, it is not troublesome and settles spontaneously. However, in 2-5% of patients, rebound sweating can be severe and disabling. In rare cases, the rebound is so severe the patient regrets the operation. Unfortunately, it cannot be reversed with further surgery. Some patients, for example those with facial and scalp sweating and older patients, are at greater risk. In most but not all, rebound sweating settles with time.

Pneumothorax or air around the lung may occur, but is usually of no significance. If, however, the pneumothorax is large, treatment may be required. A tube can be inserted into the chest through one of the incisions to alleviate the problem and is immediately effective and performed while asleep. In nearly all cases, the tube can be removed the following day, leaving little or no impact on the length of hospital stay.

Horner’s syndrome can occur if the sympathetic nerve supply to the eye is ablated. This results in constriction of the pupil, and some drooping of the upper eyelid (ptosis). Fortunately, this is rarely seen as the sympathetic nerves responsible for the eye reside in the stellate ganglion, which is usually not in the operative field.

Pleurisy may occur due to inflammation of the lining of the lung (pleura) and occurs commonly two or three days after the ETS surgery. It is often perceived as a pulled muscle between the shoulder blades and can sometimes cause severe pain but is usually controlled with anti-inflammatories. Pleurisy invariably settles spontaneously.

Dry hands - although this is the aim for many patients, those undergoing sympathectomy for other causes such as facial blushing or axillary hyperhidrosis need to be warned of this. The problem of dry hands is easily remedied with moisturisers.

Gustatory sweating involves facial sweating following meals, particularly spicy foods, and occurs to some extent in 5 to 10% of patients.

Bradycardia or slowing of the pulse may occur but is never of any clinical significance.

Why do I sweat so much?

If you are sweat excessively, you may have a condition called hyperhidrosis. This means that your sympathetic nervous system is excessively stimulating your sweat glands. It is normal to sweat when we get hot or when we are under stress. When you have hyperhidrosis, you can sweat anytime, even when you are not hot or not stressed.
In virtually all cases, there is no underlying disorder. This condition can have a major impact on a person’s confidence, raising anxiety levels and causing even more sweating.

Is ETS considered major surgery?

Although ETS is performed using minimally invasive techniques, it is considered a major surgical procedure. The procedure requires a general anaesthetic, and involves interruption of the nerve signals from the sympathetic chain to the sweat glands.

What is the success rate?

The success rate varies according to the indication for the procedure. For patients undergoing the procedure for sweaty hands, the success rate is 100%. ETS is also highly effective at eliminating facial blushing, with success rates over 90%. The success rates for patients with underarm (axillary) sweating is 70%.

Is ETS suitable for every patient?

ETS is not suitable for all patients with excessive sweating. For example, sweating on the torso, front and back, is unlikely to be helped with ETS. It is effective in treating facial and scalp sweating, but these patients have a much higher incidence of rebound sweating. Give us a call to discuss your condition and whether ETS is right for you.

Do I need to stay in the hospital for ETS?

Most patients undergoing ETS stay overnight, and are discharged from hospital the day after the procedure. However, it can be performed as a day procedure, with discharge a few hours after ETS. You can discuss this option with Mr Bell.

When can I return to work after ETS?

We usually recommend a week off work, certainly if work involves strenuous activity. It is not uncommon to experience back pain 3 to 4 days after the procedure. Having said that, we are aware that many of our patients return to work a lot sooner!

Can ETS be reversed?

Due to fear that some patients might develop severe rebound sweating, some surgeons undertook clamping the sympathetic chain, in the hope that removing the clamp might reverse the effects of the sympathectomy, in the event of bad rebound. Whilst theoretically possible, this does not work at a practical level. For all intents and purposes, ETS should be considered an irreversible procedure resulting in a permanent solution.

Is the procedure painful?

Most patients wake with chest heaviness, which settles readily in the recovery room. It is common to experience pain between the shoulder blades 3 to 4 days after the procedure. It is sharp in nature, worse with coughing and sneezing, and often perceived as a torn muscle. It responds to anti-inflammatories such as Nurofen.

Are there any long-term adverse effects?

Compensatory sweating is the most feared complication of ETS. 30 to 40% of patients experience compensatory sweating but it is very mild in the majority. In 2%, the rebound can be troublesome (i.e. occurring on the torsos at rest even on cool days. Those unfortunate enough to develop severe rebound, often regret having the procedure).

For more information about the benefits of ETS surgery,

Call us now on 1800 793 289 today.