Frequently Asked
Questions
Here is a list of Frequently asked Questions
answered by several surgeons. Please note that
WorldWide Surgeries does not endorse or favor any
specific answer by a surgeon. This is only for
information purpose. We suggest that you also
gather information concerning ETS from other
sources
QUESTIONS AND
ANSWERS BY DR. ALAN CAMERON (LONDON)
What is hyperhidrosis?
Sweating
in excess of that required to cool the body.
What is ETS and ETS-C?
ETS
is destruction of part of the
sympathetic chain (by cautery or resection)
whereas ETS-C is a technique of interrupting the
nervous impulses by applying titanium clips
across the nerve trunk.
How is ETS and ETS-C
performed?
Both
are performed under general anaesthesia and
involve passing a telescope across the chest
cavity from incision(s) near the armpit. The lung
is depressed by passing carbon dioxide into the
chest cavity to permit a good view of the
sympathetic chain which is then treated as above.
The CO2 is then removed from the chest and the
lung re-inflated.
What is the Kuntz
nerve and how does it relate to the ETS /
ETS-C procedure?
The
Kuntz nerve most probably has no function in man
and is unrelated to the success of either ETS or
ETS-C (SEE BELOW).
Are there any negative
side effects of the operation?
As
with all surgery, there is a slight risk in the
procedure, but the long-term side-effects include
compensatory hyperhidrosis, possible
excess dryness of the hands/upper body, and a
slight possibility of Horner's syndrome of
drooping of the eyelid (NOT the whole face as
some people think).
Are there any other positive
side effects of the operation?
The
dry hands may be a bonus actually; also the
palpitations and general anxiety in social
situations may be reduced.
What complications may
occur?
The
risks of the procedure include damage to the
structures inside the chest; the commonest is to
the lung which might require temporary use of a
chest drain (4%); bleeding from inside the chest
is fortunately rare (0.3%) but is much more
serious. There is usually a mild degree of
postoperative pain for a couple of days.
What if my only condition is
axillary (armpit) sweating?
ETS
is not advisable as the CS is just as bad as the
axillary sweat, merely moved around the body.
Botox or sweat gland excision is better.
What if my facial redness is
caused by rosacea or another skin condition?
ETS
might affect any attacks of flushing, but not the
background redness, so it is not recommended.
What is the long-term
success rate?
99%
for palmar hyperhidrosis (maintained for many
years). Facial blushing 94% and facial sweating
90% initially but the longterm results for these
conditions are not as good due to the problem of
compensatory sweating.
What is the recovery time?
Usually
overnight in hospital and a couple of days off
work. Sport after a week.
QUESTIONS AND
ANSWERS BY DR. CHIEN-CHIH LIN (TAIWAN)
What is hyperhidrosis?
Hyperhidrosis
is excessive sweating on certain parts of human
body, for example, hands, feet, armpits and
face. Hyperhiderosis has nothing to do with
environment temperature but is influenced by
emotional excitement. It possesses
hereditary tendency.
What is ETS and ETS-C?
The
full name of ETS is Endoscopic Transthoracic
Sympathectomy (or Sympathicotomy), which means
cutting sympathetic nerve (sympathicotomy) or
removing a sympathetic ganglion (sympathectomy).
I designed and invented ETS-C (or ESB) to treat
hyperhidrosis in 1996. The full name of ETS-C or
ESB is Endoscopic Thoracic Sympathetic Block by
clamping. I have used this new method to
treat more than 1500 cases of sympathetic
disorders with excellent operative results. ETS-C
(or ESB) means interrupting sympathetic nervous
conduction by clamping with a titanium clip and
then therapeutic purpose is achieved. No cut
of nervous trunk is performed on clamping
method, for this sake, it possesses
reversible potential by removal of the clip when
patient can not tolerate the postoperative
condition. The commonest cause of regret is
reflex sweating (previously called compensatory
sweating).
There are more than 30 surgeons using ETS-C or
ESB in sympathetic surgery in the world now.
What is ESB-4?
I am
the first person that found the
mechanism of hyperhidrosis and the postoperative
reflex sweating, so I designed ESB procedure in
sympathetic surgery. ESB4 means block 4th segment
of Thoracic Sympathetic Ganglion to treat hand
and armpit sweating problems. The speciality of
ESB4 is which can treat hand or armpit sweating
(Bromidrosis) effectively without inducing reflex
sweating. No other sympathetic procedure can
treat hyperhidrosis without inducing reflex
sweating.
How is ETS and ETS-C
performed?
Both
are performed by endoscopic method and effective
to treat sympathetic disordes under general
anesthesia. ETS, irreversible method, is cutting
sympathetic nervous trunk to treat sympathetic
disorders, but ETS-C (or ESB) without cutting
nervous trunk, reversible method.
What is the Kuntz
nerve and how does it relate to the ETS /
ETS-C procedure?
I
don't think that Kuntz's fiber plays any role in
surgical failure of sympathetic surgery after my
more than 5000 cases of clinical study. I don't
cut Kuntz's fiber when I perform sympathetic
surgery, but the operative results are the same
with any other surgeons' in the world.
What about
"micro-surgery"?
I
don't agree with the term of Micro- or selective
sympathetic surgery, because thermal or electric
burn cannot be avoided if a surgeon uses electric
diathermy probe to cut sympathetic nervous fibers
selectively unless he uses endo-scissors to cut
the nervous fibers. That means, thermal
injury to nervous fibers is the reason of
surgical effect, not selectively cut the nervous
fibers. I don't believe it unless after
a long-term follow-up.
Are there any negative
side effects of the operation?
The
most famous side effect of sympathetic surgery is
reflex sweating (compensatory sweating is a wrong
medical term). The incidence of other side effect
is rare.
What complications may
occur?
Complication
is rare when ETS-C (ESB) is used.
What if my only condition is
axillary (armpit) sweating?
Of
course, armpit sweating (Bromidrosis) can be
treated by sympathetic surgery. The procedure of
treating armpit sweating is different from hand
and facial sweating or blushing. I use different
sympathetic procedures to treat different
sympathetic disorders under the rule of
Lin-Telaranta Classifications. Lin-Telaranta
Classification emphasizes the concept of
different procedures for different sympathetic
disorders, then better operative results, less
side effect or complication are achieved.
Lin-Telaranta Classifications are the most
important concept in sympathetic surgery in the
world now.
What if my facial redness is
caused by rosacea or another skin condition?
No,
in the contrast, facial blushing induces
rosacea if facial blushing is lasting longer
enough.
What is the long-term
success rate?
What
kind of sympathetic disorders? Long term success
rate is over 99% of Hyperhidrosis, but it is
about 90% of cure rate for facial blushing.
The older and longer the patients
have facial blushing, the less cure rate is found
on them.
What is the recovery time?
Patient
is usually recovered on the next day after
operation. Sometimes, it is not common, patients
feel chest pain, tight or back sore more than one
week. Resuming normal activity as soon as
possible can speed recovery.
QUESTIONS AND
ANSWERS BY DR. JOĆO DUARTE (BRAZIL)
What
is hyperhidrosis?
Hyperhidrosis
is a dysfunction of the sudomotor center, the
center in the brain that controls the body
temperature, which promotes excessive stimuli to
sweat glands in specific areas, independent of
physiological necessity. The cause is unknown.
Hyperhidrosis can occur in any part, but the
hands, the feet, the underarms, and the face, in
isolation or in combination, are the most
affected areas.
What
is ETS and ETS-C? How is ETS and ETS-C performed?
The
best manner to treat hyperhidrosis is to
interrupt the stimulus from the sudomotor center
to the affected area. For palmar, axilar, and
facial areas the stimulus is interrupted to those
areas by removing or cutting the sympathetic
trunk and its rami. In the past it was necessary
to open the chest cavity to do this. In 1947, Dr.
E. Kux and his nephew, Dr. Peter Kux, developed
the endoscopic access to perform this operation-
Endoscopic Thoracic Sympathicotomy (ETS) surgery,
which was spread after the development of the
videoendoscopic surgery. In 1997, Dr. Lin
presented at the II International Symposium of
ETS his experience in clipping the sympathetic
trunk, instead of removing or cutting, in order
to keep the possibility of reversing the surgery
if strong compensatory sweating occurs.
What
is the Kuntz nerve
and how does it relate to the ETS /
ETS-C procedure?
The
Kuntz nerve is a ramus of the second and/or the
third sympathetic thoracic ganglion that
participates in carrying the sympathetic stimulus
to the facial area. The sympathetic stimulus is
responsible for the facial sweating, blushing,
and rhinitis.
What
about "micro-surgery"?
Micro-surgery
is the ETS performed with thin surgical
instruments, smaller than 5 mm.
Are
there any negative
side effects of the operation?
The
worst side effect is the increase of sweating on
the belly, back, and/or legs, known as
Compensatory Sweating (CS). The characteristic of
CS is different from the hyperhidrosis. Rarely
does it occur in cold weather or during emotional
stress. It is disproportional with the amount of
exercise that is done or the temperature. A short
walk or a small increase of temperature promotes
excessive sweat in the above areas. The incidence
of compensatory sweating depends on the surgical
technique.
Care
should be taken in patients with bradicardia (low
heart rate below 60 beats per minutes). The areas
of the sympathetic trunk that carry signals to
the heart should be avoided in order not to
diminish the heart rate even more.
Are
there any other positive
side effects of the operation?
Depending
on the level of the sympathetic trunk operated
and the rami cut we can diminish or sometimes
cure plantar hyperhidrosis, cure facial blushing,
diminished or cure acne and rhinitis. Subjective
positive effect like increased self confidence,
reduced anxiety, depression, and aggressiveness
can also be obtained. Patients become happier
after the surgery.
What
if my only condition is axillary (armpit)
sweating?
Like
palmar and facial hyperhidrosis, axillary
hyperhidrosis can be a great handicap in the
patients’ lives. Using the Duarte-Kux
technique, we can cure axillary sweating in 96%
of the patients operated on. If you feel that
your axillary sweating is a problem in your life,
the most efficient, safest, and easiest solution
is the Duarte-Kux technique.
What
is the long-term success rate?
With
the Duarte-Kux technique, the long-term success
rate is:
Palmar hyperhidrosis:
100% of cure
Facial hyperhidrosis
and blush: 99% of cure
Axillar hyperhidrosis:
96% of cure
About
plantar hyperhidrosis, 94% of the patients
operated on reported a reduction of the sweating
in this area, allowing them to wear sandals
without problem.
What
is the recovery time?
With
the Duarte-Kux technique, the surgery is usually
performed on an outpatient basis and, if no
complication occurs during the surgery, all
patients are able to return to their normal
activities the day after surgery (driving,
working, practicing sports, dating, etc).
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