The application of thoracoscopic sympathectomy for the optimal management of hyperhidrosis and severe upper extremity ischemia

Abstract EN

Background: The thoracic sympathectomy is traditionally performed through open surgical thoracotomy. It is an extensive procedure associated with an unacceptable inconvenience.

The present study describes a less morbid and minimally invasive thoracoscopy as the procedure of choice for thoracic sympathectomy. Methods: The present study, carried out during 2001 to 2005, was performed on 33 patients aged from 17 to 18, with a mean of 42.7 years and comprising 25 males and 8 females.

They suffered from essential hyperhidrosis and severe upper extremity ischemia, which were unsuitable for revascularization.

Of 33 patients, 15 had Buerger’s disease, 3 emboli, 5 essential hyperhidrosis, 3 Raynaud’s syndrome, 3 intra-arterial injections, 2 advanced arthrosclerosis, 1 acute thrombosis, and 1 patient post-traumatic ischemia.

The patients were indicated to undergo a probable emergency thoracotomy.

They were anaesthetized using one lung endobronchial intubations and underwent a two-port videothoracoscopy.

Sympathetic chain resection was limited to T2–T3 and lower third of the stellate ganglion.

The patients were kept under careful observation and comparisons were made between their preoperative and postoperative symptoms.

Moreover, the early and late complications were carefully documented and analyzed. Results: The presenting symptoms included 11, 4, 4 and 3 cases of ulcer and gangrene, rest pain, cyanosis and cold extremities, as well as excessive hand sweat respectively.

The foregoing thoracic sympathectomy led to corresponding complete and partial recovery of 31 and 2 patients. Conclusion: Thoracoscopic sympathectomy is a simple, safe, reliable and cost effective therapy with surprisingly good results and low complications in patients with primary hyperhidrosis as well as limb threatening upper extremity ischemia, an entity unsuitable for revascularization. Additionally, the results of sympathectomy for ischemia of upper are much better than lower extremities, so the procedure could be advised liberally for such patients.