Endoscopic Thoracic Sympathectomy (ETS)

Endoscopic thoracic sympathectomy (ETS) is a surgical procedure to alter nerve signaling between the nervous system and sweat glands.

Endoscopic Thoracic Sympathectomy Overview - 1187

The Skinny

Average Recovery

1 weeks




Surgical Procedure




$8000 - $10000

The Specifics

What is endoscopic thoracic sympathectomy (ETS)?

Endoscopic thoracic sympathectomy (ETS) is a surgical treatment to reduce excessive sweating typically in the palms (palmar hyperhidrosis). This invasive procedure is a last resort option for candidates who have failed all alternative therapies including antiperspirants, Botox® (botulinum toxin), miraDry, and Qbrexza®.

ETS is a thoracic surgery that uses small incisions in the armpits to access the sympathetic nerve as it runs through the chest cavity. ETS has very high risks of severe side effects (like compensatory hyperhidrosis), and is usually only used in the treatment of severe refractory palmar hyperhidrosis and not axillary hyperhidrosis. All other treatment options should be considered prior to considering an ETS procedure.

What cosmetic concerns does ETS treat?

  1. Excessive Sweating: An ETS surgery or endoscopic thoracic sympathectomy strategically cuts the sympathetic nerve to stop nerve signaling between the spinal cord and sweat glands.

Who is the ideal candidate for ETS?

The ideal candidate for ETS surgery has severe refractory hyperhidrosis that has failed all other treatment modalities. ETS is more commonly used for palmar hyperhidrosis. ETS is not recommended for those who have not trialed all alternative therapies, those who cannot tolerate the side effects of the procedure, and those with certain medical conditions.

What is the average recovery associated with ETS?

Most patients stay in the hospital overnight following an ETS surgery. Soreness and bruising at the incision sites may last for a few days. Most patients return to work and resume normal activities within one to two weeks.

What are the potential side effects of ETS?

Possible side effects of ETS surgery include compensatory sweating, Horner’s syndrome, gustatory sweating, nerve pain, low heart rate, dry facial skin, and brachial plexus injury.

What can someone expect from the results of ETS?

ETS surgery will produce immediate and permanent results. There is no known reversal procedure so side effects should be seriously considered.

What is the average cost of ETS?

The average cost of ETS is $8,000 to $10,000. The actual cost of ETS will vary by location, healthcare provider, and individual candidate needs.


  • Permanent
  • Effective For Palmar Hyperhidrosis


  • Expensive
  • High Risk Of Severe Side Effects

Invasiveness Score


Invasiveness is graded based on factors such as anesthesia practices, incisions, and recovery notes common to this procedure.

What to Expect

ETS therapy is a surgical treatment. Here is a general guide for what to expect before, during, and after ETS use:

The Takeaway

ETS is an invasive surgical procedure with high risk of severe side effects used as a last line therapy in the treatment of palmar hyperhidrosis, and, sometimes, axillary hyperhidrosis.

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Source List


AEDIT uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Sharon Orrange, MD, MPH Is Your Medication Making You Sweat? 10 Drugs That Cause Excessive Sweating as a Side Effect goodrx.com


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