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What is the success rate?
Is this a new procedure?
Do I need to stay overnight in the hospital?
What are the side effects?
Does hyperhidrosis get better on its own?
Can ETS be reversed?
Who should have ETS?
If I sweat all over my body, will ETS work for me?
Is hyperhidrosis hereditary?
Are there any restrictions after ETS surgery?
Is clamping better than cutting?
Are all cutting techniques the same?
What should I do to be evaluated for ETS?
When can I return to work?
Are there sutures that need to be removed?
Is any follow up required after surgery?
Will my insurance cover this procedure?
Can I fly after ETS?
What is Botox®? How does it work?
What is the success rate?
ETS is very effective in eliminating palmar hyperhidrosis. You will awaken in the recovery room with warm dry hands. Rarely will ETS fail to eliminate palmar hyperhidrosis. ETS also eliminates facial blushing and facial sweating in patients with this manifestation. In approximately 50% of patients with excessive foot sweating, that too is eliminated. Read more...
Is this a new procedure?
No. Surgical sympathectomy for palmar hyperhidrosis has been performed for well over 30 years. What is new is a minimally invasive approach to this very bothersome problem. Previously surgery required a large incision either in the back of the chest or in the neck to gain exposure to the sympathetic nerve. The new endoscopic approach allows surgeons to gain access to the sympathetic nerve via microscopic, painless incisions. The camera magnifies the nerve so that even the small branches are visible.
Do I need to stay overnight in the hospital?
No. This is an outpatient procedure. Most patients leave the hospital several hours after completion of the procedure. Long acting local anesthesia is placed into the incision to minimize the discomfort. You will be seen by Dr. Gorenstein before being discharged from the hospital and again in the office several days later to check the incisions. Regular activity can be resumed within days of the procedure.
What are the side effects?
Compensatory sweating is the most common side effect after ETS. Most patients will exhibit this after surgery. It is usually very mild, and not bothersome considering the tremendous benefit of dry warm hands. The type of sympathectomy performed depends on the patient's symptoms. This has been shown to reduce the risk of severe compensatory sweating. Click here to learn about the other possible side effects.
Does hyperhidrosis get better on its own?
No. Symptoms of palmar hyperhidrosis tend to develop in adolescence or early adulthood. Once symptoms occur they tend to worsen over time and do not spontaneously disappear. Not all patients with this problem require surgery. In some people, bothersome hand sweating only occurs under severe stress. In others it is present nearly all the time, and any stressful situation exacerbates the problem. These individuals will require surgery to alleviate the problem as no other therapy can effectively and permanently alleviate severe hyperhidrosis.
Can ETS be reversed?
ETS should be considered a permanent procedure, and therefore is reserved for patients with severe palmar hyperhidrosis and facial blushing. The clamping technique was introduced so that if compensatory sweating is severe, the clamps can be removed and compensatory sweating eliminated. To date there has not been any large studies that prove reversibility by removing clamps. There are some encouraging case reports that suggest reversal is possible.
Who should have ETS?
If you suffer from severe palmar sweating or facial blushing that has not responded to other treatments, you should consider ETS. Severe axillary (arm pit) sweating can also be cured with ETS, although this form of hyperhidrosis can also be treated with Botox®.
If I sweat all over my body, will ETS work for me?
ETS is intended to cure palmar hyperhidrosis and facial blushing. If you sweat profusely all over your body, you will not benefit from ETS. There could be other causes for your symptoms such as hyperthyroidism and you should consider seeking medical attention.
Is hyperhidrosis hereditary?
There may be a genetic component to hyperhidrosis. We are currently looking at first degree relatives of people with hyperhidrosis and are performing tests to see if genetics plays a role in this disorder.
Are there any restrictions after ETS surgery?
There are no physical restrictions after ETS. It is usual to have some incisional pain after surgery. You may shower the next day. The sutures are beneath the skin and dissolve.
Is clamping better than cutting?
I do not believe there is any essential difference between the two techniques regarding the elimination of palmar hyperhidrosis, provided they are performed correctly. In order for the clamping technique to be effective, the nerve is clamped and permanently disrupted. Theoretically the clamp can be removed and the nerve function restored, however this has not yet been proven to work all the time. A potential problem with the clamping technique is failure to eliminate hyperhidrosis; if the clamps are incorrectly placed on the nerve or if they slip off soon after the procedure. The cutting technique is certain to stop hyperhidrosis, and there is no risk of late failures or recurrence. To date only anecdotal reports about reversal are available, but there seems to be about a 50% chance of reversing the side effects if the clamps are removed.
Are all cutting techniques the same?
No. There are different ways in which the sympathetic nerve can be divided. Dr. Gorenstein uses a harmonic scalpel to divide the nerve. This instrument does not use electric current so there is less trauma to surrounding tissues and other nerves in the area of the sympathetic nerve.
What should I do to be evaluated for ETS?
If you would like to be evaluated by a physician at the Center for Hyperhidrosis at Columbia University Medical Center you may contact us by phone or by email to schedule a consultation. After a thorough examination and discussion about ETS, you can decide if you would like to proceed with ETS.
When can I return to work?
Most patients return to work within 24 to 48 hours of the procedure.
Are there sutures that need to be removed?
The microincisions are closed with a single absorbable suture that does not need to be removed. You can shower the day after the procedure.
Is any follow up required after surgery?
Dr. Gorenstein will see you immediately after the procedure, and before you are discharged home. A follow-up appointment with the doctor is scheduled one week from surgery.
Will my insurance cover this procedure?
Palmar hyperhidrosis is a well-recognized medical condition with serious physical and psychological side complications when not treated. Most insurance companies and HMOs provide full coverage for ETS.
Can I fly after ETS?
Yes. We recommend that you stay in New York until being seen by Dr. Gorenstein, and obtaining a chest X-ray to be sure there is no pneumothorax before flying.
What is Botox®? How does it work?
Botox® is a formulation of Botulinum Toxin Type A. It is produced by a naturally occurring bacteria, but today is manufactured under strict control in a laboratory. Botox® blocks the neurotransmission from the sympathetic nerves in the skin to the sweat glands and reduces excessive sweating in the areas that are injected. The effects last between 4 to 6 months and the treatments will need to be repeated.
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