Endoscopic thoracic sympathectomy

Abstract

Thoracic sympathectomy has evolved as a treatment option for patients with hyperhidrosis and pain disorders. In the past surgical procedures were highly invasive and caused significant morbidity, but the minimally invasive thoracoscopic procedure provides detailed visualization of the sympathetic ganglia and is associated with minimal postoperative morbidity. In a previously published series the authors performed 60 thorascopic procedures in 39 patients; in this paper, they report the addition of 52 procedures performed in 26 patients, for a total of 112 procedures in 65 patients. Overall, the outcomes were equivalent to those for previously established open surgical techniques; however, the rate of surgery-related morbidity, length of hospital stay, and time until return to normal activity were substantially reduced. Complications and recurrence of symptoms were comparable with those demonstrated in previous reports. Overall patient satisfaction and willingness to undergo a repeat operative procedure ranged from 66 to 99%. Postoperatively, higher satisfaction rates were observed in patients with hyperhidrosis whereas in those with pain syndromes, satisfaction rates were lower. Minimally invasive thoracoscopic sympathectomy procedures are useful in treating sympathetically mediated disorders, and the results indicated that the procedure is associated with reduced morbidity and similar outcome when compared with results obtained after open surgery. Hyperhidrosis is well treated, but patients with pain syndromes have significantly poorer outcomes.