Thoracic sympathectomy: a review of current indications

Hashmonai, M; Cameron, A. E. P.; Licht, Peter B.; Hensman, Chris; Schick, Christoph

doi:10.1007/s00464-015-4353-0

Cited by 27 publications

(18 citation statements)

References 186 publications

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“…Chung et al have reported that the SG and the second thoracic ganglion (T2) are fused in 9.1% of patients 14 . Failure in the accurate identification of thoracic ganglia may result in operation failure and severe complications 2 , 15 .…”

Section: Introductionmentioning

confidence: 99%

Near-infrared Intraoperative Imaging of Thoracic Sympathetic Nerves: From Preclinical Study to Clinical Trial

Zhou

Yang

et al. 2018

Theranostics

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The sympathetic nervous system controls and regulates the activities of the heart and other organs. Sympathetic nervous system dysfunction leads to disease. Therefore, intraoperative real-time imaging of thoracic sympathetic nerves (ITSN) would be of great clinical significance for diagnosis and therapy. The aim of this experimental study was to evaluate the feasibility and validity of intraoperative ITSN using indocyanine green (ICG).Methods: ITSN using ICG was performed on 10 rabbits to determine its feasibility. Animals were allocated to two groups. The rabbits in one group received the same dose of ICG, but were observed at different times. The rabbits in the other group were administered different doses of ICG, but were observed at the same time. Signal to background ratio (SBR) was measured in regions of interest in all rabbits. Furthermore, fifteen consecutive patients with pulmonary nodules were intravenously injected with ICG 24 h preoperatively and underwent near-infrared (NIR) fluorescence imaging (FI) thoracoscopic surgeries between July 2015 and June 2016. A novel self-developed NIR and white-light dual-channel thoracoscope system was used. SBRs of thoracic sympathetic nerves were calculated in all patients.Results: In the preclinical study, we were able to precisely recognize each rabbit's second (T2) to fifth (T5) thoracic ganglia on both sides of the spine using ITSN with ICG. In addition, we explored the relationship between SBR and the injection time of ICG and that between SBR and the dose of ICG. Using the novel dual-channel thoracoscope system, we were able to locate the ganglia from the stellate ganglion (SG) to the sixth thoracic ganglion (T6), as well as the chains between these ganglia in all patients with a high SBR value of 3.26 (standard deviation: 0.57). The pathological results confirmed our findings.Conclusion: We were able to use ICG FI to distinguish thoracic sympathetic nerves during NIR thoracoscopic surgery. The technique may replace the rib-oriented method as standard practice for mapping the thoracic sympathetic nerves.

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Section: Introductionmentioning

confidence: 99%

Near-infrared Intraoperative Imaging of Thoracic Sympathetic Nerves: From Preclinical Study to Clinical Trial

Zhou

Yang

et al. 2018

Theranostics

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“…PNS denervation is used for the treatment of gastric ulcers 17 and may occur as a consequence of gastric bypass surgery. 18 SNS denervation is currently used to treat hyperhidrosis, 19 facial blushing, 20 and a variety of other conditions, 21 New treatments involving autonomic denervation may also be implemented in the future for other diseases involving autonomic imbalance, such as rheumatoid arthritis 22 or chronic pain. 23 Identifying whether intestinal regeneration is chronically disrupted after these procedures is important because alterations are known to lead to aberrant tissue function.…”

Section: Introductionmentioning

confidence: 99%

Long-term effect of parasympathetic or sympathetic denervation on intestinal epithelial cell proliferation and apoptosis

Davis

Washington

Yaniz

et al. 2017

Exp Biol Med (Maywood)

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This study investigates the long-term effect of autonomic denervation on intestinal epithelial cell turnover, as measured by proliferation, apoptosis, and total cell number. Although previous research has established that autonomic denervation can alter intestinal epithelial turnover under short-term conditions, here we establish for the first time that these changes do not persist long-term when you control for surgical-induced changes in food intake and use targeted denervation procedures. These findings add to the base of knowledge on autonomic control of tissue turnover, highlight the ability of the intestinal epithelium to recover after autonomic injury and reveal possible implications of the use of ANS denervation for disease treatment in humans. AbstractIntestinal epithelial tissue is constantly regenerated as a means to maintain proper tissue function. Previous studies have demonstrated that denervation of the parasympathetic or sympathetic nervous system to the intestine alters this process. However, results are inconsistent between studies, showing both increases and decreases in proliferation after denervation of the parasympathetic or sympathetic. The effect appears to correlate with (1) the timing post-denervation, (2) denervation-induced changes in food intake, (3) the denervation technique used, and (4) which intestinal segment is investigated. Thus, we proposed that parasympathetic or sympathetic denervation does not have an effect on intestinal epithelial regeneration when you (1) evaluate denervation after long-term denervation, (2) control for post-surgical changes in food intake, (3) use minimally invasive surgical techniques and (4) include a segmental analysis. To test this, adult male Sprague Dawley rats underwent parasympathetic denervation via subdiaphragmatic vagotomy, sympathetic denervation via celiacomesenteric ganglionectomy, a parasympathetic denervation sham surgery, or a sympathetic denervation sham surgery. Sham surgery ad libitum-fed groups and sham surgery pair-fed groups were used to control for surgically induced changes in food intake. Three weeks post-surgery, animals were sacrificed and tissue from the duodenum, jejunum, and ileum was excised and immunohistochemically processed to visualize indicators of proliferation (bromodeoxyuridine-positive cells) and apoptosis (caspase-3-positive cells). Results showed no differences between groups in proliferation, apoptosis, or total cell number in any intestinal segment. These results suggest that parasympathetic or sympathetic denervation does not have a significant long-term effect on intestinal epithelial turnover. Thus, intestinal epithelial regeneration is able to recover after autonomic nervous system injury.

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“…However, it is rightly very explicit about the need for the most thorough information for patients regarding possible side effects and about the fact that the symptoms are not always relieved [1]. Also, in a recent review of current indications for thoracic sympathectomy, Hashmonai et al [2] have stated that sympathetic ablation is an effective treatment for facial blushing, while stressing the importance of being conservative in the use of this procedure, a view we agree with.…”

mentioning

confidence: 82%

Facial blushing: relevance of psychiatric consultation prior to surgery

Jadresic

2016

Clin Auton Res

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Thoracic sympathectomy: a review of current indications

Cited by 27 publications

References 186 publications

Near-infrared Intraoperative Imaging of Thoracic Sympathetic Nerves: From Preclinical Study to Clinical Trial

Near-infrared Intraoperative Imaging of Thoracic Sympathetic Nerves: From Preclinical Study to Clinical Trial

Long-term effect of parasympathetic or sympathetic denervation on intestinal epithelial cell proliferation and apoptosis

Facial blushing: relevance of psychiatric consultation prior to surgery

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