What is the difference between clamping and cutting in ETS?

I do not believe there is any essential difference between the two techniques for endoscopic thoracic sympathectomy (ETS) regarding the elimination of palmar hyperhidrosis, provided they are performed correctly. In order for the clamping technique to be effective, the nerve is clamped and permanently disrupted. Theoretically, the clamp can be removed and the nerve function restored; however, this has not yet been proven to work all the time. A potential problem with the clamping technique is failure to eliminate hyperhidrosis -- if the clamps are incorrectly placed on the nerve or if they slip off soon after the procedure. The cutting technique is certain to stop hyperhidrosis, and there is no risk of late failures or recurrence. To date only anecdotal reports about reversal are available, but there seems to be about a 50% chance of reversing the side effects if the clamps are removed.

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