CHOOSING AN ETS SURGEON

So you have gone through this website and the Hyperhidrosis Forum in detail and experimented with all the various non-surgical hyperhidrosis treatments available -- but nothing has worked well. You have now decided on getting endoscopic thoracic sympathectomy surgery despite understanding all the possible complications and side effects that can arise from destroying part of your sympathetic nervous system. I will now offer you advice on how to go about choosing a surgeon (ironically, I followed almost none of this advice and just selected the most experienced surgeons in the world when I had my surgery in 1998). Keep in mind that although your hand sweating is almost guaranteed to cease post ETS surgery, 100 percent of people get at least one side effect after surgery (most frequently, compensatory sweating). Additionally, regret at having the operation can arise over time based on changing body conditions and side effects. Perhaps the biggest problem with having this kind of surgery is psychological. You are manipulating a part of your body that is directly and indirectly connected to many other parts, and this can lead to confusion in the long term when you suffer any kind of medical ailment and are unable to decide whether it was caused or exacerbated by endoscopic thoracic sympathectomy or something that would have happened irrespective of surgery. Having been in touch with numerous ETS patients over the years, including those who had open sympathectomy many decades ago, I feel that ETS side effects in general are not the cause of anything that endangers your life, so do not worry about that. The side effects can cause a significant decline in your quality of life though, but those too depend on your genetic ability to cope with and tolerate discomfort, your social and family support system, your daily work environment and enjoyment of work ans so on.

How experienced is the surgeon -- A good place to see this is: ETS surgeon rankings. In some surgeons' cases, this ranking doesn't mean much, since the numbers might be exaggerated and not verified by any third party (even worse is if a surgeon claims to have done over 500 ETS surgeries, but has not published the numbers in any kind of prestigious journal and never attended any international symposium on ETS). Moreover, experience does not always equate to skillfulness and ethical behavior either. Nevertheless, you still do not want to be a guinea pig and go to a surgeon who has performed less than 50 ETS surgeries. It seems that the sympathetic nervous system is located somewhat differently from person to person, and the body is not symmetrical on each side -- so only experienced surgeons can most accurately determine the location of the stellate, T-2, T-3, T-4 etc... ganglions on each side of the body.

Is the surgeon looking out for your best long-term interests and not just focusing on short-term benefits -- call a surgeon anonymously several times and ask him the following questions: whether he will perform ETS for only armpit sweating; whether he will perform lumbar sympathectomy for only feet sweating; whether he will perform ETS for some shyness/social phobia that you may have; whether he will perform ETS for general body sweating. If the answer to any of those questions is an affirmative, choose another surgeon. Note that some well respected surgeons treat severe social phobia with ETS after lengthy patient analysis and consultation, but no ethical surgeon would make such a decision during a five minute phone conversation. Lumbar sympathectomy on men was becoming obsolete due to sexual and other side effects, but since 2008 this procedure has seen a resurgence. I have terrible feet sweating, but rather than getting this kind of surgery, I have found other means to cope with it. Armpit sweating can easily be treated by Botox, creams, liposuction and more. Moreover, it is natural for armpits to sweat and if you are a heterosexual male you are in luck since women apparently like sweaty male armpits!

Surgeon reputation amongst his peers -- This involves checking up on the surgeon's qualifications, how long the surgeon has been doing ETS for, whether he has attended any of the symposiums on thoracic sympathectomy, whether he has been trained by any of the world's most experienced ETS surgeons such as Claes/Drott/Lin/Tarfusser/Telaranta, whether other surgeons have positive things to say about the surgeon you are going to see, whether the surgeon has published any articles in prestigious medical journals detailing long-term results of and experience with ETS and so on.

Patient testimonials -- All experienced surgeons should be able to provide you with a list of former patients who you can talk to. You should get a list of at least 50 patients from a surgeon and talk to all the patients in this list who had ETS surgery done on them at least three years beforehand. Their overall experiences are invaluable, especially the changes they experienced in terms of compensatory sweating and thermoregulation over the years after surgery. Did the surgeon have them fill out satisfaction surveys at least up to two years post ETS? How was the hospital stay and staff? If not, the surgeon could be exaggerating his patient satisfaction rates since some side effects appear several years post ETS. I do not know of a single surgeon who also provides a list of negative testimonials, but sometimes you can find such patients posting on online forums or consumer websites about lawsuits against ETS surgeons -- e.g., lawsuits and busted and more lawsuits.

Basic consultation and first impressions before surgery -- Are you comfortable speaking with the surgeon in your first language? This is more important than one realizes, especially since some of the most experienced surgeons are not native English speakers. Many surgeons never meet the patient till the day of the operation (something to avoid if possible, or at least make sure the surgeon sees pictures of your sweaty hands to judge how bad they are), and you do not want to have language difficulties right before surgery -- especially with current trends in surgery such as the Lin-Telaranta classification making it imperative to consult with the surgeon and make sure the right ganglions are destroyed. You might be a patient who only wants hand sweating stopped and want facial sweating to continue. In that case, the surgery is less intensive and the T-2 ganglion is untouched. However, improper communication would lead to the surgeon assuming that you want to also stop facial sweating. Did the surgeon ask and advise you about trying alternative treatments such as iontophoresis, creams, botox and so on? Does the surgeon perform numerous other oftentimes medical or cosmetic procedures besides ETS? That would be a red flag for me, especially if the procedures are cosmetic. You want to go to a surgeon who is devoted to ETS and other thoracic procedures rather than someone who is trying to do to many things at one time.

Clamping versus cauterization versus cutting versus microcutting versus resection versus Lin-Telaranta classification versus.... -- There are so many techniques of doing ETS nowadays that one needs to be expeditious in doing research about which technique seems best -- especially since some surgeons are differentiating themselves in the market by minute variation in technique. Some surgeons still destroy T-2 for hand sweating, while other destroy T-4 per the Lin-Telaranta classification (supposedly leading to fewer side effects as innervation to the upper body from T-2 is not cut off). It is probably safe to say that a majority of surgeons around the world clamp the ganglion, but many other still cauterize or cut the ganglion. In my opinion, the effectiveness of clamping reversal is minimal at best -- although I would still prefer clamping over cauterization or cutting just due to less surrounding scar tissue and damage. Check out ETS surgery evolution and ETS reversal myth before deciding on the best technique for you.