ETS stands for Endoscopic (using very narrow surgical tools and a tiny camera) Thoracic (in the chest) Sympathectomy (killing part of the sympathetic chain of ganglia). For a more complete answer, go here.

Why do people have ETS?

Thoracic sympathectomy has been practiced regularly since 1920, attempting to treat a great long list of problems. Today, the most common indications for ETS are "hyperhidrosis", facial blushing, Raynaud's disease and anxiety.

What are the benefits of ETS?

ETS surgery will alter the function of many organs, glands and muscles. Viewed one at a time, and depending on the original complaint, many of these effects could be considered a benefit. For example, ETS typically will lower heart rate and contraction strength. If the patient feels their heart is overactive, such as in panic attacks, the lowered cardiac output could be considered a benefit. It is thought (but not clinically proven) that ETS will lower the risk of heart arythmia and palpitations. As another example, ETS will cause blood vessels in the skin to be paralyzed fully dilated. If the patient feels their blood vessels are overly constricted, as in Raynaud's syndrome, this could be considered a benefit. The most common example, of course, is sweating. ETS will stop all sweating in the denerved area. If the patient believes they sweat excessively, this could be considered a benefit.

What are the risks of ETS?

Please see this side effects page.

Don't all surgeries have some risk?

"No surgery is without risk". This statement is certainly true, but often used to mislead. All surgeries have a risk of bleeding and infection, and complications due to anesthesia. But then there are specific risks associated with specific surgeries. I have voiced the opinion that patients have a right to be informed of procedure-specific risks. Some medical professionals disagree, suggesting that it is sufficient that a patient merely understand the general risk, regardless of the specifics.

Is ETS reversible?

No. Because of devastating ETS side effects, there is great demand for a reversal procedure. Three types of reversal procedures are available, none has proven effective. For patients who were cut or burned, there are 2 different nerve graft "reversal" operations available, sural and intercostal. In the sural nerve graft (SNG), a piece of the sural nerve is harvested from the left calf and glued into the damaged areas of the sympathetic chain. In the intercostal version (ICNG), intercostal nerves are cut away from the ribs and flopped over onto the damaged area. This method has the advantage of an intact blood supply to the donor nerves. With all nerve graft operations, it should be understood that the donor nerve does not replace the damaged nerve tissue. Rather, the donor nerve acts as a "scaffolding" to support the attempted regeneration of the damaged tissue. For patients who were clamped, the clamps can be removed. It appears that the window of opportunity is only a few days or weeks at most before the clamped nerve tissue is dead. All current "reversal" operations carry the risk of making things worse by damaging more tissue in the process.

What are the differences between all the different ETS methods?

ETS methods differ according to which surgical instruments are used, and which specific area of the sympathetic chain is being targeted. The surgeon may use electrocautery to burn tissue, a metal knife blade to cut tissue, or a harmonic scalpel which cuts tissue very precisely using ultrasound waves. Or, the surgeon may instead crush the nerve tissue with titanium clamps, which are then left inside the body.

Different regions along the sympathetic chain correspond roughly to different areas of the body, but there is overlap in function, and great variation from one patient to the next. Most ETS occurs around the T2-T4 area, with differing opinions among surgeons as to which level or levels to kill in order to treat specific complaints.

What is meant by T2, T3, etc.?

The sympathetic chains run down the inside of the back of the chest wall, along either side of the spine. "T" stands for "thoracic" and the the number indicates the ganglion which is closest to a particular rib, T1 being near the first thoracic rib, T2 being near the second, and so on.

What is informed consent?

Patients have the right to be told of the known risks and benefits of a surgery before giving their consent to proceed.

What is compensatory sweating?

After ETS surgery, most patients will sweat profusely from areas of the body such as the belly, lower back, crotch, and legs. This is called compensatory sweating or reflex sweating.

My surgeon lied to me. Can I sue him?

You can try. For a number of reasons, successfully suing a surgeon is extremely difficult. Laws such as "damage caps" are specifically crafted to protect doctors against lawsuits. It is quite expensive to prosecute any medical case, easily running $50,000 or more. ETS is substantially more complex than a typical medical case, because it involves so many different parts of the body. There is no guaranteed right to an attorney in a civil matter. A medical case requires medical expert witnesses to testify, and these people are typically very unwilling to say anything which makes another doctor look bad. Medical doctors enjoy a privileged status in our society. Unfortunately, some have chosen to abuse this privilege for their own gain.

Can you recommend a good lawyer?

No. In my experience, plaintiff's attorneys are very reluctant to prosecute cases involving ETS surgeons. In fact, it appears that plaintiff's attorneys actually work to protect the surgeons, not prosecute them.

Who is behind this website?

My name is Alex Baker, I had T2-T4 sympathectomy in October 2002. I am not a doctor, I am not a lawyer. I was born in 1960, I live in Southern California with my wife and kids. I suffer many disabling effects of ETS, and my family suffers as a result. We're trying to make the best of it.

Why should I believe anything on this website?

The picture of ETS painted here is certainly much different than the one painted by ETS surgeons on their sites. While ETS surgeons make good money marketing the procedure, I have nothing to sell. The medical information is referenced to published studies, textbooks and such. It is my sincere desire to present factual information as fact, opinion as opinion. It is my policy to correct errors if they are made known to me. While several ETS surgeons have expressed displeasure, none have ever pointed out anything incorrect. TruthAboutETS is offered as a public service, and is the site I wish I had seen prior to my ETS.

How can sweat gland surgery affect so many parts of the body?

Though it is often presented that way, ETS is not sweat gland surgery. It is surgery designed to kill part of the sympathetic chain of ganglia. The same nerves which run to the sweat glands are all bundled together with nerves that run to the heart, lungs, blood vessels, thyroid gland, bone, bone marrow, and many other organs, glands and muscles.

Why do you put "hyperhidrosis" in quotes?

"Hyperhidrosis" means "excessive sweating disease". In my opinion, excessive sweating is not a disease. It is embarrassing, and the embarrassment can cause people to dislike or avoid social situation, lowering the quality of life. But from a physical point of view, excessive sweating is harmless.