The overactive sympathetic nerve and ganglia are identified. The Harmonic Scapel which is an ultrasonic vibrating device is used to carefully dissect a small segment of the sympathetic nerve without damaging the nerve or the surrounding structures. The neural transmissions in these nerves are then interrupted precisely at a specific level either by clipping or by microcutting . It is very important to perform this part of the operation with great precision to avoid complications. The instruments are then removed, and the wounds are closed with internal sutures.
Scars are minimal and well hidden.
This procedure takes about 30 minutes on each side. The relief of sweating is immediately noticed by the patient upon waking up from anesthesia. Most patients can resume physical activity, and return back to work within one week or less. During the ETS procedure, this nerve is also carefully looked for and its neural transmissions are interrupted. One of the reasons for failure of ETS procedure is not interrupting neural transmission in the nerve of Kuntz.