ETS+ELS: Combined Thoracic and Lumbar Sympathectomy for Hyperhidrosis


Hyperhidrosis and Facial Blushing

- Hyperreactivity of the Sympathetic Nervous System -

ETS and ELS in one single session

In the past, ETS alone had been claimed to reduce also foot sweat in around half of the patients suffering from palmo-plantar hyperhidrosis. Unfortunately, studies have shown that in a majority this improvement is only partial and of limited duration: while the hands remain permanently dry, the feet tend to return to the original sweating level again within months.

Our vast experience with ETS (25+ years) and ELS (10+ years), encompassing over 3500 procedures and implementing continuous improvements in order to maximize the desired result and reduce side-effects, have lead us to move further and offer the patients with palmo-plantar hyperhidrosis a single step solution.

As the first team worldwide, we are performing endoscopic thoracic and lumbar sympathectomy bilaterally in one single session.


Patients suffering from essential palmo-plantar hyperhidrosis with severe to extreme sweating of hands and feet (wet or even dripping) are suitable for the combined approach if the plantar component is very troublesome, insufficiently responsive to conventional treatment, and if the patient is reluctant to undergo multiple procedures and anesthesia.

The operation

As with the single procedures, the combined one is performed in general anesthesia with single-lumen tube. Sequentially, the right and left lumbar sympathectomy of L3-4 in retroperitoneoscopy is followed by left and right thoracoscopic sympathectomy of T3.


Complications of the combined surgery are very rare and are analogous to the separate procedures (ETS or ELS).

The combined operation does not require a longer hospital stay than ETS or ELS alone (24 hours) and does not add additional side effects compared to the single procedures. In fact, the level of post-operative compensatory sweating is heavily dependent on the type of surgical technique used by the surgeon for the thoracic part (ETS). By optimizing the method by

  • adopting maximum precision when interrupting the sympathetic chain
  • limiting the block of the sympathetic chain to the absolutely essential
  • paying attention on not creating unstable neuropathic foci in the ganglia due to partial thermal damage

the side effects can usually be kept at a more than acceptable minimum.
ELS does not appear to increase compensatory sweating significantly.
Serious adverse effects such as compensatory hyperhidrosis (= extreme compensatory sweating) have virtually disappeared with the adoption of the aforementioned principles of improved surgical technique. Unfortunately, sympathetic surgery is often still performed using suboptimal technique that involve greater risk of major or even debilitating side effects.


We perform the procedure at the St. Anna's Clinic in Merano, Italy.
For further information contact the surgeon directly:
  Dr. Ivo Tarfusser, MD
    ph: +39-335-241686