Anatomical redistribution of sweating after T2–T3 thoracoscopic sympathicolysis: a study of 210 patients

Ramos, Ricard; Moya, Juan; Macía, Iván; Morera, R.; Escobar, Ignacio; Pace, Valerio; Rivas, Francisco; Masuet, Cristina; Saumench, J.; Villalonga, R.

doi:10.1007/s00464-007-9262-4

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…However, sweating increased in areas where perspiration had been absent, minimal, or inconsequential before surgery-a finding that corresponds with those described in the literature [12][13][14].…”

Section: Discussionsupporting

confidence: 73%

Quantification of eccrine sweat glands with acetylcholine sweat-spot test and anatomical redistribution of sweating after T2–T3 thoracoscopic sympathicolysis

et al. 2008

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It is well-known that Cannon's law of denervation (1939) is not applicable to the sweat glands, that is, there is no hyperactivation following intradermal acetylcholine stimulation. However, some response, which increased over the first 6 months following surgery, was observed in our study. Nevertheless, this activation is subsequently self-limiting, resulting in no gland atrophy, and reinnervation occurs without patient awareness.

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Section: Discussionsupporting

confidence: 73%

Quantification of eccrine sweat glands with acetylcholine sweat-spot test and anatomical redistribution of sweating after T2–T3 thoracoscopic sympathicolysis

et al. 2008

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“…Compensatory hyperhidrosis is the most troublesome side effect and the leading complications after upper thoracic sympathetic surgery for upper essential hyperhidrosis (Chou et al, 2006;Yang et al, 2007). In current surgical practice, the wide availability and application of thoracoscopic surgery offers a safer and technically easier surgical option; this has led to an increase in the number of sympathicotomy being undertaken (Ramos et al, 2007;Baumgartner, 2008;Walles et al, 2009). The increasing use of thoracoscopic sympathicotomy has prompted a reappraisal of the sympathetic outflow to the upper limb and the causes of failures following surgery (Kwong et al, 2008;Weksler et al, 2008).…”

Section: Discussionmentioning

confidence: 97%

Anatomical variations of the upper thoracic sympathetic chain

Zhang

Yang

et al. 2009

Clinical Anatomy

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The aim is to clearly delineate the upper thoracic sympathetic chains and neural connections between the chains and ventral rami of the thoracic nerves, and to provide an anatomical foundation for successful upper thoracic sympathicotomy for treating upper essential hyperhidrosis. The upper thoracic sympathetic chains, upper five intercostal nerves, and neural connections between them in 50 halves of 25 adult cadavers have been dissected, measured, and mapped. The stellate ganglion had an incidence of 80%. The second to the fourth thoracic sympathetic ganglia were commonly located in the corresponding intercostal spaces with the presence of 92%, 68%, and 50%, respectively. The incidence of the first and second intercostal rami was 40% and 6%, and that of the ascending or descending rami from the second, third and fourth ganglia was 54%, 24%, and 14%, respectively. Additional rami communicantes joined the ventral ramus of the 1st thoracic nerve proximal to the point where the latter gave a branch to the brachial plexus. The farthest horizontal distance from the sympathetic chain to the junction between the additional rami communicantes and the second to the fourth intercostal nerves was 29.1 mm. Only 16% of cadavers had similar anatomy bilaterally. Anatomical variations of the upper thoracic sympathetic trunk in relation to intercostal nerves, which may be one of the causes resulting in surgical failures and recurrences, were striking. Attention should be given to such anatomical variations when planning thoracic sympathicotomy.

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“…Nevertheless, the level at which thoracic ganglia dissection should be performed is still unclear; good results have been reported at the T2, T2-T3, and T3 levels, and even at lower levels (with less anhidrosis but also decreased compensatory sweating). We perform T3 sympathectomy based on our clinical observation of over 1,000 patients with hyperhidrosis and lower risk of compensatory hyperhidrosis [4,10,[20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…If performed by experienced thoracic surgery departments, the complication rate is negligible, with the most common undesirable effect being compensatory sweating [4][5][6][7][8][9][10][11][12]. One possible complication of sympathectomy that we must be alert to is Horner's syndrome, with an incidence rate ranging from 0 to 4% according to recent reports [13][14][15][16].…”

Section: Introductionmentioning

confidence: 96%

Impact of T3 thoracoscopic sympathectomy on pupillary function: a cause of partial Horner’s syndrome?

et al. 2011

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T3 sympathectomy leads to subclinical pupillary dysfunction with a tendency for miosis, even though this impairment is not generally evident on standard physical examination or reported by patients. This subclinical dysfunction may be caused by injury to an undefined group of presympathetic nerve cell axons in caudocranial direction that communicate with the cervical sympathetic ganglia and whose function is mydriatic pupillary innervation.

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Anatomical redistribution of sweating after T2–T3 thoracoscopic sympathicolysis: a study of 210 patients

Cited by 10 publications

References 21 publications

Quantification of eccrine sweat glands with acetylcholine sweat-spot test and anatomical redistribution of sweating after T2–T3 thoracoscopic sympathicolysis

Quantification of eccrine sweat glands with acetylcholine sweat-spot test and anatomical redistribution of sweating after T2–T3 thoracoscopic sympathicolysis

Anatomical variations of the upper thoracic sympathetic chain

Impact of T3 thoracoscopic sympathectomy on pupillary function: a cause of partial Horner’s syndrome?

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