Research on 'ETS &Reversals'

In our recent online survey with 64 participants, 57 post-operative patients voted that they would have an 'ETS reversal' surgery if it would offer them at least a 50% relief of their symptoms. View the survey here

Please not that the number in the circle represents other participants that have already voted. Eg. '+54' means 54 participants voted plus the visible facebook profile images, so 3 visible, therefore 57 voted 'yes'

Scientific Literature on Negative Side Effects of ETS

Title: "Thermoregulatory disorders and illness related to heat and cold stress"

Author: William P. Cheshire Jr., MD


Article Link Here: https://www.autonomicneuroscience.com/article/S1566-0702(16)30001-7/fulltext


Image Source/Citation: Cheshire W.P. (2016) Autonomic Neuroscience: Basic and Clinical, 196 , pp. 91-104, https://doi.org/10.1016/j.autneu.2016.01.001

Abstract: "Thermoregulation is a vital function of the autonomic nervous system in response to cold and heat stress. Thermoregulatory physiology sustains health by keeping body core temperature within a degree or two of 37 °C, which enables normal cellular function. Heat production and dissipation are dependent on a coordinated set of autonomic responses. The clinical detection of thermoregulatory impairment provides important diagnostic and localizing information in the evaluation of disorders that impair thermoregulatory pathways, including autonomic neuropathies and ganglionopathies. Failure of neural thermoregulatory mechanisms or exposure to extreme or sustained temperatures that overwhelm the body's thermoregulatory capacity can also result in potentially life-threatening departures from normothermia"

Title: "Selective sympathectomy for hyperhidrosis: technique of robotic transthoracic selective postganglionic efferent sympathectomy "

Author: Hans Coveliers,Mark Meyer Farid, Gharagozloo Willem Wisselink


Article Link Here: https://academic.oup.com/ejcts/article/43/2/428/468484


Image Source/Citation: European Journal of Cardio-Thoracic Surgery, Volume 43, Issue 2, February 2013, Pages 428–430, https://doi.org/10.1093/ejcts/ezs411

Quote: "compensatory hyperhidrosis (CH) is seen in ∼50–97% of patients who undergo this technique"

Summary: This paper supports the statistic that compensatory hyperhidrosis can be seen in up to 97% of patients (This refers to excessive sweating in other areas of the body after the sympathetic chain has been interrupted) and explores alternative methods of ETS that does not involve direct damage to the sympathetic chain.

Note from ETS Awareness.org: The significance of the statistic is due to several patients reporting their doctors claiming a 1-2% chance of compensatory hyperhidrosis.

Scientific Literature on Sympathetic Nerve Reconstruction

Title: "Reconstruction of the Sympathetic Chain"

Author: Dr. Cliff P. Connery, MD


Article Link Here: https://www.thoracic.theclinics.com/article/S1547-4127(16)30028-7/fulltext


Image Source/Citation: Reconstruction of the Sympathetic Chain ,Connery, Cliff P. Thoracic Surgery Clinics , Volume 26 , Issue 4 , 427 - 434. doi: https://doi.org/10.1016/j.thorsurg.2016.06.007

Summary: Dr. Connery describes a brief history of ETS reversal and performs series of sympathetic nerve reconstructions after on three post-ETS patients by his team. Two of the three with significant improvements in heart rate, compensatory sweating, and one of the three with a reduction of compensatory sweating, but no change in quality of life. This paper goes into the advantages of robotic surgery which includes, high-magnification, three-dimensional optics, scaling of motion , distal articulation, and microinstrumentation.

Note from ETS Awareness.org: Our administration has contacted the 1st patient performed on by Dr. Connery and it is worth noting that after not being able to sweat from his upper extremities (above the nipple line), he can now sweat from his arms, axillary area, minimally on the upper chest, and regained his "cognitive/emotional function up to 100%".

Title: "Robotic intercostal nerve graft for reversal of thoracic sympathectomy: a large animal feasibility model"


Authors: M. J. Latif, J. N. Afthinos, C. P. Connery, N. Perin, F. Y. Bhora, M. Chwajol, G.J. Todd, S. J. Belsey

Article Link Here: https://onlinelibrary.wiley.com/doi/abs/10.1002/rcs.205

Image Source/Citation: Latif, M. J., Afthinos, J. N., Connery, C. P., Perin, N. , Bhora, F. Y., Chwajol, M. , Todd, G. J. and Belsley, S. J. (2008), Robotic intercostal nerve graft for reversal of thoracic sympathectomy: a large animal feasibility model. Int. J. Med. Robotics Comput. Assist. Surg., 4: 258-262. doi:10.1002/rcs.205

Summary: Surgical team perform sympathetic nerve reconstruction with animal models, using the Da Vinci robot and intercostal nerve from a lower T-level as a nerve graft for the sympathetic chain. This was sutured from the proximal nerve stump to the distal peripheral nerve stump. This type of nerve grafting is referred to as a 'bridge graft'; not to get this confused with the Lin technique, where one end of the intercostal is flipped into the proximal end of the sympathetic chain.

Evidence of nerve regrowth of the new graft and sympathetic trunk was then observed after several weeks with an electron microscope

Current Reconstruction Methods (Post-2016)

Side-To-Side or End-To-Side Coaptation

Dr. Tommy Chang a reconstructive microsurgeon from Taipei, Taiwan has began performing Sympathetic Nerve Reconstruction for post-ETS patients. So far he has performed this procedure on 10 patients. He uses the sural nerve and end-to-end coaptation technique to connect the nerve graft from the peripheral nerve endings of the sympathetic trunk and also to the underlying intercostal nerves with either side-to-side or side-to-end reconstruction techniques. All of his surgeries for this are performed with the Da Vinci Robot.

Note from ETS Awareness.org: Our administration has contacted the 1st patient performed on by Dr. Chang and she has displayed significant improvements in her compensatory sweating, emotional side effects from ETS, and dryness of scalp. Still there is not enough data to support that this is the most practical solution.

Logic Behind Side-To-Side

and End-To-Side coaptation

In patients who undergo an endoscopic thoracic sympathectomy and when the chosen surgical method involves removal of ganglia then the white ramus communicans and gray ramus communicans will most likely be found ruptured. Instead of just replacing the portion of the sympathetic trunk it may be logical to also reconnect the single nerve graft to any intervening intercostal nerves since these do also play a role in communication from the central nervous system to the peripheral nervous system. The way we've seen the intercostal reconnected thus far has been through side-to-side coaptation or side-to-end coaptation.

Real Video Footage of Sympathetic Chain Reconstruction ('ETS Reversal')

Videos of nerve reconstruction using a double sural graft technique provided exclusively for ETSAwareness.org by Dr. Tommy Chang(Reconstructive Microsurgeon) and Dr. Yin-Kai Chao(Thoracic Surgeon) from Chang Gung Memorial Hospital of Taipei, Taiwan.

Image of final result by Dr. Tommy Chang and Dr. Yin-Kai Chao

Results of Reversal