What are the other Names for the Procedure?
- Endoscopic Thoracic Sympathectomy (ETS)
- ETS (Endoscopic Thoracic Sympathectomy)
What is Dorsal Sympathectomy surgical procedure?
Dorsal Sympathectomy is a surgical procedure that involves removing part of the dorsal sympathetic nerves (part of the autonomic nervous system), which surround the spinal cord within the upper part of the back.
What part of the Body does the Procedure involve?
Dorsal Sympathectomy involves the dorsal sympathetic nerves, which control the contraction and expansion of small arteries within the arms, lungs, and upper ribs.
Why is the Dorsal Sympathectomy surgical procedure Performed?
A Dorsal Sympathectomy is performed for the following reasons:
- Restoring normal supply of blood to the arms
- Removing part of the sympathetic nerve that causes spasms within the blood vessels
- To treat excessive sweating (hyperhidrosis)
What are some Alternative Choices for the Procedure?
A Sympathectomy procedure is performed when medical management of the condition has failed. Hence, there are no alternatives to surgery.
What are the Recent Advances in the Procedure?
The minimally-invasive techniques for performing a Dorsal Sympathectomy have undergone further refinement.
What is the Cost of performing the Dorsal Sympathectomy surgical procedure?
The cost of Dorsal Sympathectomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding Dorsal Sympathectomy and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
Prior to Dorsal Sympathectomy surgical procedure:
How is the Dorsal Sympathectomy surgical procedure Performed?
The Dorsal Sympathectomy procedure may be performed under general anesthesia.
Endoscopic Thoracic Sympathectomy (ETS):
- After inserting a tube in the airway to aid breathing, an incision is made below the armpit (chest region)
- The lung on the side of surgery is allowed to deflate (to help get space for the operation)
- A tube fitted with a camera (a special instrument called a thoracoscope) is inserted into the chest. Additional small incisions are made through which surgical instruments are introduced
- The appropriate nerves are identified and cut (which turns of sweating)
- The surgical instruments are removed after the lung is re-expanded
- A temporary tube (plastic drain) may be left in place for some time to help remove any air or fluid in the chest
- The incisions are sutured
Where is the Procedure Performed?
A Dorsal Sympathectomy surgical procedure is performed in a hospital
Who Performs the Procedure?
The Dorsal Sympathectomy procedure is performed by any of these medical personnel, with or without assistance from an anesthesiologist:
- General surgeon
- Vascular surgeon
How long will the Procedure take?
The procedure may take a few hours to perform.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Dorsal Sympathectomy procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding, and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Dorsal Sympathectomy procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Dorsal Sympathectomy surgical procedure?
Before a Dorsal Sympathectomy procedure, the patient has to undergo certain tests such as:
- Routine blood and urine analysis
- Chest x-ray
- Electrocardiography (ECG)
- Diagnostic sympathetic nerve block
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Dorsal Sympathectomy surgical procedure?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests or periodic visits to the healthcare facility required after the procedure?
- What are the costs involved?
During the Dorsal Sympathectomy surgical procedure:
What kind of Anesthesia is given, during the Procedure?
General anesthesia by injection and inhalation is administered prior to the procedure.
How much Blood will you lose, during the Procedure?
There is not much blood loss during an uncomplicated Dorsal Sympathectomy surgery.
What are the possible Risks and Complications during the Dorsal Sympathectomy surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness such as autoimmune disorders or chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the Dorsal Sympathectomy surgery are:
- Excessive bleeding
- Infection within the surgical wound
- Anesthetic complications
- Accidental injury to lung tissue
- Lung collapse
What Post-Operative Care is needed at the Healthcare Facility after the Dorsal Sympathectomy surgical procedure?
- After the Dorsal Sympathectomy procedure, the patients are sent to an area of the hospital called the postoperative recovery area (or PACU)
- The patient’s blood pressure, heart rate, and respiration cycle, shall be closely monitored. Any additional pain associated with the procedure will be treated
- Individuals are usually discharged from the hospital about 1-3 days after the surgery is performed
After the Dorsal Sympathectomy surgical procedure:
What are the possible Risks and Complications after the Dorsal Sympathectomy surgical procedure?
The possible risks and complications that may arise after Dorsal Sympathectomy procedure are:
- Excessive bleeding
- Infection within surgical wound
- Lung collapse
What is the Prognosis after the Surgery?
A complete recovery from a Dorsal Sympathectomy procedure is usually achieved. The prognosis is generally excellent and no serious complications are noted.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Pain that worsens and swelling around the surgical wound
- Excessive bleeding or fluid drainage from the surgical wound
- The occurrence of any symptom that causes uneasiness such as nausea, vomiting, abdominal swelling, or constipation
- Feeling cold, numbness, or noticeable discoloration in the hand
- Difficulty breathing, pain within the chest
- Signs of an infection
- Headache, muscle aches
- Fever, feeling sick
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Dorsal Sympathectomy surgical procedure?
At home, the following post-operative care is recommended, after a Dorsal Sympathectomy procedure:
- Slowly resume regular/daily activities as early as possible, which aids in faster recovery
- Women may be required to use sanitary napkins (for bleeding) for about a week or more
- Use a heat pad or warm compress to relieve pain due to the incision
- Resume showering and keep the wound clean and dry. Gently wash the surgical wound with a mild, unscented soap
- Elevate legs while resting to prevent the formation of blood clots and reduce the possibility of swelling
- Complete the course of prescribed medication as advised by your physician
- Take stool softeners to prevent constipation, under advice of the physician
- Take antibiotic medication to help combat or prevent infection, under advice of the physician
- Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain
- Avoid all activities that are physically strenuous for about 6 weeks after surgery
- Resume driving only after 2 weeks of being discharged from the hospital, or when advised by the physician
- Avoid sex till complete healing has taken place (under advise by the physician)
- Individuals are advised to have to clear liquids immediately after surgery, until the gastrointestinal tract begins properly functioning. Then proceed to eat a well-balanced diet, which can aid in a faster recovery. After a complete recover has occurred, maintain a low-fat, low-salt diet
How long does it normally take to fully recover, from the Procedure?
Recovery from the procedure may take a few days to weeks.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision.
- Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Dorsal Sympathectomy surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- A hospital
- An anesthesiologist (if anesthesia was administered)
- A pathologist
- A general surgeon, neurosurgeon, or a vascular surgeon
The patient is advised to inquire and confirm the type of billing, before the Dorsal Sympathectomy is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA