Drawbacks of endoscopic thoracic sympathectomy

Ojimba, T.; Cameron, A. E. P.

doi:10.1002/bjs.4511

Cited by 83 publications

(61 citation statements)

References 23 publications

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“…In general, however, this is considered not more than a nuisance and does not affect overall patient satisfaction. However, a small percentage (1-2%) of patients regret the intervention afterwards [85][86][87][88][89].…”

Section: Results and Complicationsmentioning

confidence: 99%

Advanced techniques in medical thoracoscopy

Tassi¹,

Davies²,

Noppen³

2006

European Respiratory Journal

103

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For expert pulmonologists, advanced procedures in medical thoracoscopy are the nonroutine and more complex applications of the method. The main current indications are the treatment of infected pleural space, forceps lung biopsy and sympathectomy.In parapneumonic effusions and empyema, medical thoracoscopy is as a drainage procedure, intermediate between tube thoracostomy and video-assisted thoracoscopic surgery (VATS), which is efficient, significantly lower in cost and avoids surgical thoracoscopy under general anaesthesia. It is essential that it is performed early in the course of the disease and is particularly advisable for frail patients at high surgical risk.The efficacy of forceps lung biopsy has been demonstrated in diffuse lung diseases, whereas results in localised lung diseases and chest-wall lesions have been less positive. However, VATS is currently the preferred approach for these indications. The technique still maintains its efficacy for visceral pleura and peripheral lung biopsy, in particular in the presence of pleural effusion and lung disorders.At the present time, thoracoscopic sympathectomy is minimally invasive and is an accepted intervention for patients with a variety of autonomous nervous system disturbances. Essential hyperhidrosis patients, and well-selected patients with other disorders, can be helped with this procedure, which can also be performed by interventional pulmonologists.

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Section: Results and Complicationsmentioning

confidence: 99%

Advanced techniques in medical thoracoscopy

Tassi¹,

Davies²,

Noppen³

2006

European Respiratory Journal

103

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“…The lack of published data on adverse events following sympathetic blockade with or without radiological (fluoroscopic) guidance makes comparison of our complication rates difficult. Since the introduction of thoracoscopic sympathectomy techniques in the 1980s, only one review of the procedure's safety has been published [23]; in this, the incidence of pneumothorax was given as 2%, though up to 75% of the patients had some residual intrathoracic gas at the end of the procedure that required drainage in 0.4-2.3% of cases; this compares with a 0.9% incidence of pneumothorax in our case series. Surgical emphysema is also a common adverse event during thoracoscopic sympathectomy, occurring in 2.7% of patients; no such events were observed in our patients.…”

Section: Discussionmentioning

confidence: 69%

Interventional management of intractable sympathetically mediated pain by computed tomography‐guided catheter implantation for block and neuroablation of the thoracic sympathetic chain: technical approach and review of 322 procedures

et al. 2011

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SummaryWe retrospectively evaluated the safety and efficacy of computed tomography-guided placement of percutaneous catheters in close proximity to the thoracic sympathetic chain by rating pain intensity and systematically reviewing charts and computed tomography scans. Interventions were performed 322 times in 293 patients of mean (SD) age 59.4 (17.0) years, and male to female ratio 105:188, with postherpetic neuralgia (n = 103, 35.1%), various neuralgias (n = 88, 30.0%), complex regional pain syndrome (n = 69, 23.6%), facial pain (n = 17, 5.8%), ischaemic limb pain (n = 7, 2.4%), phantom limb pain (n = 4, 1.4%), pain following cerebrovascular accident (n = 2, 0.7%), syringomyelia (n = 2, 0.7%) and palmar hyperhidrosis (n = 1, 0.3%). The interventions were associated with a total of 23 adverse events (7.1% of all procedures): catheter dislocation (n = 9, 2.8%); increase in pain intensity (n = 8, 2.5%); pneumothorax (n = 3, 0.9%); local infection (n = 2, 0.6%); and puncture of the spinal cord (n = 1, 0.3%). Continuous infusion of 10 ml.h )1 ropivacaine 0.2% through the catheters decreased median (IQR [range]) pain scores from 8 (6-9 [2-10]) to 2 (1-3 [0-

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“…The limited data available confirm that one of the commoner reported complications from thorascopic sympathectomy is compensatory sweating. 15 Some degree of compensatory sweating probably occurs in all patients and rates as high as 97-100% have been reported. 16,17 The incidence will vary depending on how assiduously it is sought.…”

Section: Discussionmentioning

confidence: 99%

Thorascopic Sympathectomy Performed Using Laser

Black

Taylor

Russell

et al. 2008

annals

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INTRODUCTION Thorascopic sympathectomy is accepted as an effective treatment for palmar hyperhidrosis, facial blushing and to a lesser extent for digital ischaemia and axillary hyperhidrosis. PATIENTS AND METHODS Data were collected retrospectively on patients undergoing thorascopic sympathectomy at St Peter's Hospital between 1987 and 2006. Patients were followed up by telephone interview. RESULTS A total of 233 thorascopic sympathectomy procedures were performed by a single operator in 123 patients. Ages ranged from 9–71 years and 75 were women. In patients, 105 had a bilateral and 13 a unilateral procedure, 5 patients had a bilateral procedure performed in two stages. In 6 upper limbs, the procedure could not be done. Overall, 110 patients (90%) had the procedure performed for palmar hyperhidrosis, 8 (6%) for facial blushing and in 5 (4%) patients the operation was performed for digital ischaemia with tissue loss. There were no deaths and all patients were discharged on day 1 following the procedure. Complications included bleeding (2), pulmonary oedema (1) and failed procedure (2); however, no incidences of Horner's syndrome occurred. Only 40 of 123 (32.5%) patients gave follow-up information. Of this small group, 33 of 40 (83%) were cured, 4 of 40 (10%) were better, 2 of 40 (5%) were unchanged and 1 patient was worse. Only 22 out of 40 (55%) of these patients were troubled by compensatory sweating, with only 4 of 40 (10%) reporting this as a major problem. CONCLUSIONS Thorascopic sympathectomy is safe and can be carried out as a single bilateral procedure in the majority of cases. The laser allows the use of a single port, requires less dissection than surgical or clipping techniques, is more precise than diathermy and may be less likely to cause a Horner's syndrome.

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Drawbacks of endoscopic thoracic sympathectomy

Cited by 83 publications

References 23 publications

Advanced techniques in medical thoracoscopy

Advanced techniques in medical thoracoscopy

Interventional management of intractable sympathetically mediated pain by computed tomography‐guided catheter implantation for block and neuroablation of the thoracic sympathetic chain: technical approach and review of 322 procedures

Thorascopic Sympathectomy Performed Using Laser

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