Thorascopic Sympathectomy Performed Using Laser

Abstract

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.

Thoracoscopic Sympathectomy for Palmar Hyperhidrosis in Children: 21 Years of Experience at a Tertiary Care Center

“…18 However, it has been a major problem only in approximately 10% of the cases. 26 Most patients wanted relief of PH even at the cost of CH. 14 Shalaby et al have reported transient Horner syndrome in 13%.…”

“…22 In comparison, in our series, transient Horner syndrome was seen in 18% (8/44) patients. To reduce the incidence of Horner syndrome, some authors have recommended the use of ultrasonic shears, 28 endo clip, 27 and laser 26 to reduce the risk of nerve injury induced by the spread of electric energy and heat.…”

Electrocautery versus Ultracision versus LigaSure in Surgical Management of Hyperhidrosis

“…Although sympathectomy with clips 5 and the section of the rami communicantes (ramicotomy) and Kuntz nerve 6 have been proposed, selective bilateral sympathectomy (excision of sympathetic trunk, rami communicantes, and ganglia) seems to have the best effectiveness with total satisfaction of patients. 7 Black et al, 8 in 233 endoscopic sympathectomies with laser, revealed 0.85% bleeding, 0.43% pulmonary edema, and 0.85% failed procedure. Chang et al, 9 reevaluating retrospectively 234 patients treated with sympathectomy of T2, T3, T4 for palmar hyperhidrosis, displayed the compensatory sweating (CS) incidence of 92% T2, 92% T3, and 80% T4.…”