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What are possible risks of an endoscopic thoracic sympathectomy (ETS)?

Endoscopic thoracic sympathectomy (ETS) is performed under general anesthesia and carries the risks of any surgical procedure, namely reactions to medications, bleeding, or infections.

To perform ETS, the lung must be collapsed to allow visualization of the sympathetic nerve. Collapsing a lung during surgery is routine during all types of thoracic surgical procedures and has no associated risks. When the sympathectomy is completed, the lung is reinflated. Occasionally a small amount of residual air is left in the chest cavity. The body absorbs this air within a few days and there are no long-term effects.

Horner's syndrome may occur if the sympathetic nerve near the T1 level is also disrupted. In patients who experience Horner's syndrome, the eyelid appears to droop slightly. The other manifestations such as absent facial sweating or a sluggish pupil are rarely seen. The frequency of this is less than 1%, and in those who do experience it, it may resolve spontaneously. Careful dissection limited to the T2 level minimizes the risk of developing a droopy eyelid postoperatively. Since we now more frequently perform a T3 sympathectomy for palmar or axillary hyperhidrosis, the risk of a postoperative Horner's syndrome is much less.

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