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How is ETS performed to treat excessive sweating (hyperhidrosis)?

The most common surgery for hyperhidrosis is ETS, which allows doctors to remove sweat glands through minor incisions.

Endoscopic thoracic sympathectomy (ETS) is performed through two microscopic incisions in the armpit, or axilla. The procedure is performed under general anesthesia, and a local anesthetic is infiltrated into the skin and soft tissue to minimize any pain in the early postoperative period. Insufflating CO₂ into the chest cavity through a tiny needle displaces the lung.

Surgeons then insert two small instruments into the chest cavity: a telescope attached to a magnifying camera and a dissecting instrument. The sympathetic nerve is dissected from the surrounding tissue with the dissecting instrument as it crosses over the ribs. After the ganglia is isolated, a 5-mm clamp is placed across the nerve. The advantage of clamping is that it allows the option for reversing the procedure, should the side effects be bothersome, though this is rarely required.

After completing the sympathectomy and removing the CO₂ from the chest cavity, the lung re-expands, and the two incisions are closed. The procedure is completed on both the left and right side, and then the patient is awakened and moved to the recovery room. Patients generally leave the hospital within hours of completion of the operation.

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