History of sympathetic surgery

Abstract

The first reported operation on the upper sympathetic system was performed by Alexander in 1889. The initial indications (epilepsy, exophthalmic goiter, idiocy, glaucoma) are obsolete. For some subsequent indications (angina pectoris, vasospastic disorders, and painful conditions) sympathectomy has still a limited application. The main indications today are hyperhidrosis (since 1920) and blushing. Renewed attempts to perform the operation for psychological conditions have been reported. The technique of sympathectomy has been modified over the century, with a trend to minimize the extent of surgery: from open to endoscopic approaches; from resection of ganglia to thermoablation, thermotransection, and clipping. The sequelae of the operation (mainly compensatory hyperhidrosis) present a major problem in a small percentage of operated patients. Techniques of reversal (by nerve grafting and unclipping) have been proposed. Meticulous follow-up studies are required to evaluate the merits of these techniques. Improved knowledge of the functions and interrelations of the autonomic nervous system is required to understand the mechanism of these sequelae and learn how to avoid or treat them.

Impact of inactivity and exercise on the vasculature in humans

“…However, sympathectomized patients, who lack sympathetic vascular innervation, but participate in normal physical activity, do not exhibit the structural or functional vascular adaptations typically observed in the SCI model (Eisenach et al 2002; Hashmonai and Kopelman 2003). In addition, previous studies in SCI have demonstrated that vascular adaptations are partly reversible by electrical stimulation training of the inactive paralyzed legs in SCI (de Groot et al 2005; Hopman et al 2002; Thijssen et al 2007b).…”

Can Thoracic Sympathetic Nerve Damage Be Reversed?

“…2,3 The other indications for ETS include Raynaud phenomenon, facial blushing, moyamoya disease, and long QT syndrome. [4][5][6][7] ETS can be used bilaterally. Although one-stage surgeries are common, two-stage unilateral implementation has been shown to cause less compensatory sweating.…”

Single-port bilateral endoscopic thoracic sympathectomy for the treatment of hyperhidrosis

“…Hastaların yaş ortalaması 22.7 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) (3,6). Hiperhidrozisi tedavi etmek için ilk yapılan sempatektomi 1920 yılında Kotzaref tarafından bildirildi (8). Fakat yöntem büyük cerrahi insizyon gerektirdiği için daha sonraki yıllarda yaygın olarak kullanılmadı.…”