University of Wisconsin Cardiovascular Surgery: The ETS Sympathectomy Procedure

The ETS Sympathectomy Procedure

The ETS sympathectomy procedure takes about 40 minutes. You will be asleep during surgery.

First, an anesthesiologist inserts a tube into your trachea (the airway from your mouth to your lungs). This helps you breathe during the operation.

The surgeon then makes two small (5 mm) incisions on one side of the chest. The incisions are made just below the underarm, and are hidden in the inframammary crease.


Figure 2	Figure 3

Next, the anesthesiologist deflates the lung. This allows access to the sympathetic nerve chain, which is located inside the chest, near the spine.

The surgeon then inserts a small video camera through one of the tiny incisions. Using the video as a guide, the surgeon inserts tiny instruments into the other incision. These instruments are used to remove the branches of the sympathetic chain responsible for the sweating: the second and third ganglion, the intervening sympathetic chain, and the ventral and dorsal rami.

Once the nerve chain is removed, the surgeon removes the instruments and camera, and the anesthesiologist reinflates the lung. The procedure is then repeated on the other side of the chest.

The surgeon leaves a tiny (4 mm) chest tube on either side of the chest for a few hours after surgery. This helps the lung reopen. The remaining incisions are covered with a small bandage.