Endoscopic thoracic sympathectomy (ETS) is a surgical treatment option for various forms of hyperhidrosis. In which a portion of the sympathetic nerve trunk in the thoracic region is destroyed.It is conducted by a vascular or neurosurgeon under general anaesthesia. It has a very high success rate for treating palmar hyperhidrosis but carries a significant risk of compensatory or “rebound” sweating. Compensatory sweating occurs in areas such as the back or lower limbs weeks to months after ETS surgery. Compensatory hyperhidrosis can be difficult to treat and usually persists for life.An in-depth discussion with your vascular surgeon or neurologist is needed prior to considering ETS surgery.