Endoscopic Thoracic Sympathectomy

J.P. Johnson, MD
Chinyere Obasi, MD
Jongsoo Park, MD (Los Angeles, CA)
Michael S. Hahn, MD (New York, NY),
Paul Glatleider MD (Los Angeles, CA)

Introduction:

Thoracic sympathectomy has evolved as a treatment option for patients with hyperhidrosis and pain disorders. The more traditional surgical procedures for these conditions 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.

Materials and Methods:

The authors performed a total of II 2 procedures in 65 patients during the six year period between 1993 and 1999. Forty–eight of these patients had hyperhidrosis, 12 had pain syndromes and 5 had Raynaud's syndrome.

Results:

Of the 48 patients operated for hyperhidrosis, 47 experienced complete relief of their symptoms while one patient experienced partial relief. No patient experienced a recurrence of their palmar hyperhidrosis. Of the 17 patients with pain and vasculitic disorders, 11 experienced relief of their symptoms while 5 patients had a recurrence and one was lost to follow up. Overall patient satisfaction and willingness to undergo a repeat procedure ranged from 66 to 99% and length of hospital stay, time to return to normal activity and surgery–related morbidity were substantially reduced, compared to open thoracotomy. Complications were also few and comparable to those traditional procedures.

Discussion and conclusions:

Minimally invasive thoracoscopic sympathectomy procedures are useful in treating sympathetically mediated disorders, and the results indicate 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.