Specific complications and mortality of endoscopic thoracic sympathectomy

Abstract

Endoscopic Thoracic Sympathectomy (ETS) has gained an increasing popularity due to its minimal invasive character. Despite the simplicity of the procedure, non-surgical options should always be considered as the first line of treatment. The complication risk of ETS is low but side effects, primarily compensatory sweating (CS) of mainly the trunk may be severe enough to cause regret of the procedure. The risk/benefit ratio should always be discussed with the patient. Severe palmar hyperhidrosis and facial blushing respond very well to ETS with a high patient satisfaction rate. Facial hyperhidrosis is effectively treated with ETS but is associated with a high risk for severe CS. Axillary hyperhidrosis is best treated by other means than ETS. The use of ETS for pain syndromes, vascular insufficiency and angina pectoris is not well supported by scientific evidence, making mandatory careful patient selection.

Evaluation of plantar hyperhidrosis in patients undergoing video-assisted thoracoscopic sympathectomy

“…We have found that this is a safe procedure with low-complication rates, and this has also been found by other centers [4,6,18]. Compensatory hyperhidrosis is the most frequent problem related to VATS [27].…”

Surgical treatment of facial hyperhidrosis and blushing: mid-term results after endoscopic sympathetic block and review of the literature

“…However, one should bear in mind that although only anecdotally reported, several deaths have occurred due to sympathectomies [65,66]. At our institution, thoracoscopic sympathectomy has been performed since 1965 and roughly 1200 procedures have been performed in 600 patients.…”

Endoscopic transthoracic sympathectomy: current indications and techniques

“…Despite these low complication rates, which have been reported to be very similar by other authors, one has to bear in mind that they usually come from single centers with large experience. No mortality has been reported in these series, but from personal communications and medicolegal trials Cameron has collected information on 8 deaths [4], 4 of which were due to intraoperative hemorrhage and 3 related to anesthesia and ventilation problems.…”