Thoracoscopic sympathectomy: techniques and outcomes

Abstract

<jats:p>Thoracic sympathectomy is an important option in the treatment of palmar hyperhidrosis and pain disorders. Earlier surgical procedures were highly invasive with known morbidity, acceptable outcome, and established recurrence rates that were the limitations to considering surgical treatment. Thoracoscopic sympathectomy is a minimally invasive procedure that allows detailed visualization of the sympathetic ganglia and minimal postoperative morbidity; however, outcome studies of this technique have been limited. The authors treated 39 patients with 60 thoracoscopic procedures, and the outcomes in this small series were equivalent to previously established open surgical techniques; however, operative moribidity rates, hospital stay, and time of return to normal activity were substantially reduced. Complications and recurrence of symptoms were also comparable to previous reports. Overall patient satisfaction and willingness to repeat the operative procedure ranged from 66 to 96% in all patients. Patients and physicians can consider minimally invasive thoracoscopic sympathectomy procedures as an option to treat sympathetically mediated disorders because of the procedure's reduced morbidity and at least equivalent outcome rates in comparison to other treatments.</jats:p>

Endoscopic thoracic sympathectomy

“…[14] One finding not discussed in our earlier work was that compensatory hyperhidrosis was found to occur in 22% of patients in our series, which is consistent with that reported in other series.…”

“…[14] CONCLUSIONS In the treatment of sympathetically mediated disorders, minimally invasive techniques for thoracoscopic sympathectomy have equivalent outcomes to those reported for previous open surgical techniques; however, the associated morbidity rate and the hospital LOS are substantially reduced when utilizing these newer techniques. We recommend that surgeons undergo formal training in these procedures, with didactic and laboratory training, followed by work with an experienced surgeon who performs these procedures on a regular basis.…”

“…[3,6,14,15,17,18] Previously, sympathetically mediated syndromes required highly invasive surgical procedures to resect a relatively small portion of the upper thoracic sympathetic ganglia. [2,4,5,9,13,28,30,31] Despite these issues, previous surgical procedures produced acceptable long-term clinical results.…”

Role of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis

“…9 It is not a severe, life-threatening disease, but represents an extremely uncomfortable situation causing deep social embarrassment and relationship and psychological disorders in such patients, who frequently becomes socially isolated and acquire habits that attempt to hide the problem. Curiously, and for a variety of reasons, the proportion of such patients that have their problem solved and efficiently and lastingly treated is insignificant.…”

“…28 The video-assisted thoracoscopic procedure standardized initially by most surgeons was resection of the sympathetic trunk, from the lower part of the stellate ganglion (T 1 ) to T 4 . 9,13 In the beginning, 10-mm scopes and several instruments were used. Thoracic drainage was mostly used and many surgeons performed the bilateral operation in two different surgical sessions.…”