Sunday, May 16, 2010

Excerpts from an interview with an ETS surgeon

The following are excerpts from a recent interview between a member of the Kiwi ETS Group and a New Zealand ETS surgeon.

Interviewer: I spoke to a neurologist who said that the Sympathetic Nervous System plays a role in a lot of different functions in the body, and a couple of the ones he mentioned were: lung function, heart function…um, brain function, blood vessel function, sexual function, for example. So, what I wanted to ask you is…when the SNS is cut or cauterised – whichever method a surgeon prefers to use – how does that system maintain its equilibrium after it has been cut into?

ETS surgeon: Ah…I don’t think you can really say. A lot of the reason why the operation works is unknown. Like if you operate on someone for facial blushing…the four people I’ve done for that, I’ve told them beforehand that um, that we don’t really know why the operation should work because you’re cutting the sympathetics that normally supply the arm and they’re interested in the face.

It’s not very logical that the operation would work…like I say, you cut the sympathetics to the arm. But what you say, about what happens to the sympathetics afterwards and all that sort of stuff, I don’t really think anyone knows. And so the results...those who do get bad compensatory truncal sweating…it’s very unpredictable.

Interviewer: Is that not a concern – that the mechanism, what the surgery actually does, how it stops sweating and blushing, is not actually understood?

ETS surgeon: Yip.


Interviewer: There are two health practitioner insurers in Australia – MDVA and Avant – and they will not insure for ETS because they said they received too many complaints related to ETS for the number of surgeries being performed.

Again, is this something that is a concern to the community of surgeons doing the surgery?

ETS surgeon: Ah, I don’t think so. I don’t think that is that well known.


Interviewer: So related to all that, as well as those Australian insurance companies I mentioned not insuring practitioners for the procedure, in 2005 a Finnish Organisation – FINOHTA, the Finnish Office for Health and Technology Assessment – they did a review and their conclusion was that there was “a lack of controlled trials and no reliable evidence for the effectiveness of ETS for excessive sweating in the face and hands or for flushing in the face”. They also concluded that the treatment had no impact on social phobia and was associated with significant immediate and long term adverse affects.

Further to that, in August last year, the Australian Safety and Efficacy Register of New Interventional Procedures – surgical, they released a report. I believe it was passed on to the Royal Australasian College of Surgeons (RACS) that same month - August 2009. Their conclusion was very similar. They said there was a lack “high quality, randomised trial evidence” on the surgery that made it “difficult to judge the safety and effectiveness of the technique”. They said there is a potential number of safety issues associated with ETS surgery, and they suggested a full systematic review be undertaken to assess the safety and efficacy of the surgery.

As someone who is seeing a few patients every year for the surgery, what do you think about those two reviews? Do they concern you?

ETS surgeon: Yeah, that’s accurate. It doesn’t necessarily mean that it’s a bad operation.

Interviewer: Is it more that they’re saying there needs to be more research done?

ETS surgeon: Yeah exactly, it means that if you looked at all the studies, there’s not much useful information in it.


Interviewer: Further to what we talked about before, the review done in Finland and the one recently done by Asernip-s in mentioned an American support group. There is also a support group in Sweden, there is also a support group in Australia and there’s also one here in NZ for people who had bad outcomes from the sympathectomy surgery, and I also believe there is a Japanese language website, and a Taiwan Chinese website that were created by people who had bad outcomes from the surgery.

All these support groups and all these websites seem to suggest quite a high number of unhappy patients. What do you think about that?

ETS surgeon: You shouldn’t undertake the operation unless you’re aware there is a possibility of a bad outcome like that.

Interveiwer: Do you think there are issues around the consent process – that people aren’t being adequately warned about the possible side effects?

ETS surgeon: Ummmmmmm....probably.