Endoscopic Thoracic Sympathectomy (ETS) Risks

All surgery contains an element of risk and ETS is no different.

  • Infection.  In order to access the sympathetic nerves your surgeon needs to make incisions, immediately exposing your body to the risk of infection.  This is prevented by using sterilised equipment and using a clean operating room, however there is always a chance that something can get into your incision and cause complications. 
  • Scarring.  The incisions are placed under the arms, an inconspicuous area that is rarely focused upon.  You will be left with very small scars in this area, the largest being 1cm long, although they ought not to be noticeable.
  • Damage to neighbouring organs and blood vessels.  The use of cameras and key-hope surgical equipment means that there is a small risk of damaging veins or arteries that run close to where the nerves being cut are.  This could lead to blood loss or swelling of internal organs.
  • Compensatory sweating.  Unfortunately one serious side effect of ETS is that of compensatory sweating, and this is a very common.  In order to properly regulate your body temperature you are likely to compensate for not being able to sweat as previously in certain areas of your body.  This takes the form of a higher intensity of sweating elsewhere.  A basic example is if you had ETS to treat your palm sweating, you could end up with an increase of foot sweating instead.  This would appear to defeat the objective of the surgery, but luckily it only causes a real problem for a very low percentage of those who experience it.
  • Horners syndrome.  This can occur when a part of the sympathetic nerve is knocked or damaged causing drooping to one of your eyes, with sweating on that side of the face diminished and your eye appearing smaller than previously.  This can gradually heal, but sometimes it is a permanent problem.  The risk of this occurring is very small, but it is still possible that it could happen to you.
  • Gustatory sweating.  Having ETS surgery could result in your sweat reaction to hot and spicy foods being enhanced.  This can be slight, or an extreme difference to how you reacted to such food before.
  • Tingling sensations.  This is likely to occur because of the changes made to your nerves, and is likely to be a temporary condition that will fade over time.
  • Weight gain.  This is a rare side effect, but can occur after having ETS and is likely to subside over time.
  • Impotence.  If you try to have ETS to cure feet sweating there is a risk that your fertility could be compromised due to the positioning of the nerves.

ETS (Endoscopic thoracic sympathectomy) Pros:


  • Can permanently help with some forms of hyperhidrosis
  • Low amounts of scarring due to the key-hole surgery technique
  • Compensatory sweating often less severe than the initial hyperhidrosis

ETS (Endoscopic thoracic sympathectomy) Cons:

  • Real risk of unwanted side effects which range from slight to serious health risks
  • Compensatory sweating can be worse than the original problem
  • All of the risks of surgery are included
  • It cannot help with axillary hyperhidrosis or plantar hyperhidrosis, both serious and common forms of excess sweating.
  • Surgery can cause real pain, and it will take you a few weeks to recover completely from such surgery.

Having ETS is a serious step to take, and you ought to only do so once you have had relevant consultations with your GP and surgeon.  However, in some cases it can provide an effective relief for excessive sweating.

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