Endoscopic Thoracic Sympathectomy ( ETS )

In the clipping technique of ETS, the sympathetic nerves are not physically cut. A titanium clip is placed across the nerves to decrease the conduction through the sympathetic nerves. It is known that the compression of 30mm Hg is sufficient to inhibit the nerve conduction. However, the smaller fiber nerves that control the thermal regulation of the body may be more resistant to pressure, and less likely to be affected by this pressure. Early studies with the clipping method suggest that compensatory sweating associated with ETS appears to be less severe with the clipping method when compared with the cautery or cutting method.

The other advantage of the clamping method is that, theoretically, this operation could be reversed by removing the titanium clips. Reversal is not a guarantee and is only possible when the clips are removed soon after surgery. In this way, if the patient is not satisfied with the results of the operation, the clips could be removed, and theoretically, the operation could be reversed.

The clipping method is technically more laborious and time consuming to perform compared to the other techniques of ETS. However, we feel that the clipping method has definite advantages over electrocautery or micro cutting technique and we strongly recommend the clipping over other methods.

In this technique, the titanium clip is applied to the sympathetic nerve in a graduated fashion. The clip is gradually closed until the adequate amount of force is applied to the nerve and the desired effect is obtained. The neural transmissions are slowed down but the nerve is not crushed. This graduated clipping of the nerve is a very precise maneuver that is thought to theoretically decrease the chance of adverse side effects (such as compensatory sweating). By not completely crushing the nerve, it is also thought that the reversal of this procedure is more likely to occur after the removal of the clip.

ETS Links: [ Clipping ] [ Graduated Clipping ] [ Microcutting ] [ Superselective ]

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