THORACIC SYMPATHECTOMY

Thoracic sympathectomy using  thoracoscopy

HISTORY

Thoracic sympathectomy is an old and efficient technique that used to be practiced using thoracotomy (open chest surgery)

This procedure recently became popular again thanks to video-assisted surgery such as thoracoscopy and coelioscopy, allowing the surgery to be much less invasive using tools and a camera inserted in a small incision in the thorax. 

Such a procedure is non-invasive and provides a cure for chronic and disabling illnesses such as hyperhidrosis. 

PURPOSE

Removal of parts of the sympathetic chain controlling the function of sudoriferous glands (and hence, perspiration) in the targeted area.

THE PROCEDURE

It is a light intervention thanks to the use of thoracoscopy.

Incisions are small (5mm) and located at the base of the armpit.

A Palmer needle is inserted on the superior edge of the rib. The “palpable click” will be the tell-tale sign that the needle has now pierced the pleura. 

Delivery of up to 10mm HG of carbon dioxide.

Insertion of 2 trocars (5 mm) in the superior edge of the ribs: one for the fiber optic cable feeding the video monitor (thoracoscopy), the other to insert a dissecting tool. 

Cutting the sympathetic chain under video control.

The first sympathetic ganglia is left untouched to avoid Horner’s syndrome (an oculosympathetic palsy causing miosis, ptosis and enophtalmos). 

The resection is very small and located between the 2nd  rib the upper edge of the 3rd rib.

We can cut the sympathic chain or  put a clip.

The surgery lasts between 15 to 30min according to the surgeon’s experience. 

A thoracic drain may or may not be used. In case it is, it will be removed in the waking room, the same day the operation took place.

The histology is not controlled systematically.

ANESTHESIA  The procedure requires general anesthesia but without the need of selective intubation to avoid any morbidity caused by Carlens endotracheal tubes. 

HOSPITALIZATION   day surgery (patients are free to go the same day)

AFTER THE PROCEDURE

complete healing of the hyperhidrosis

thoracic pain increased during inspiration, during one week

rarely, compensating sweating on over zones

Any leave of absence from work or school lasts from zero to 2 days