Abstract
With the advent of video and advancement in endoscopic video-assisted techniques, the thoracoscopic approach, first described by Kux in 1951, has undergone rapid progression and is now widely accepted as the approach of choice to perform sympathectomy. Other discussions have arisen regarding the technique used: to cut, clip, or resect the upper thoracic sympathetic chain is accepted as the approach of choice, with minimal postoperative morbidity and near faultless success rate, but the optimal technique remains a subject of controversy. Some authors prefer either resection of the chain, or clipping the chain, while others prefer electrocautery ablation of the ganglia. The uniportal technique has now emerged, in an effort to minimize surgical trauma and speed up the procedure. In this chapter we discuss all of the techniques used, considering discussion and concerns arising about them, and describe their final results.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Change history
29 December 2018
Correction to: M. P. Loureiro et al. (eds.), Hyperhidrosis https://doi.org/10.1007/978-3-319-89527-7
References
Lakraj A-AD, Moghimi N, Jabbari B. Hyperhidrosis: anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins. Toxins (Basel). 2013;5:821–40. http://www.mdpi.com/journal/toxins
Sheski FD, Mathur PN, Finlay G, editors. Therapeutic uses of medical thoracoscopy therapeutic uses of medical thoracoscopy Page 2 of 5. Alphen aan den Rijn: UptoDate; 2013. p. 1–5.
Changizi M, Weber R, Kotecha R, Palazzo J. Are wet-induced wrinkled fingers primate rain treads? Brain Behav Evol. 2011;77(4):286–90.
Vretzakis G, Simeoforidou M, Stamoulis K, Bareka M. Supraventricular arrhythmias after thoracotomy: is there a role for autonomic imbalance? Anesthesiol Res Pract. 2013;2013:413985.
Cerfolio RJ, De Campos JRM, Bryant AS, Connery CP, Miller DL, DeCamp MM, et al. The society of thoracic surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011;91(5):1642–8. https://doi.org/10.1016/j.athoracsur.2011.01.105.
Ribas Milanez de Campos J, Kauffman P, Wolosker N, Munia MA, de Campos Werebe E, Andrade Filho LO, et al. Axillary hyperhidrosis: T3/T4 versus T4 thoracic sympathectomy in a series of 276 cases. J Laparoendosc Adv Surg Tech A. 2006;16(6):598–603. http://www.ncbi.nlm.nih.gov/pubmed/17243877
Licht PB, Pilegaard HK, Ladegaard L. Sympathicotomy for isolated facial blushing: a randomized clinical trial. Ann Thorac Surg. 2012;94(2):401–5. http://www.ncbi.nlm.nih.gov/pubmed/22633477
Weng W, Liu Y, Zhou J, Li H, Yang F, Jiang G, et al. Thoracoscopic indocyanine green near-infrared fluorescence for thoracic sympathetic ganglions. Ann Thorac Surg. 2016;101(6):2394. http://linkinghub.elsevier.com/retrieve/pii/S0003497516002149
Janszky I, Szedmák S, Istók R, Kopp M. Possible role of sweating in the pathophysiology of panic attacks. Int J Psychophysiol. 1997;27(3):249–52.
Méndez-Bértolo C, Moratti S, Toledano R, Lopez-Sosa F, Martínez-Alvarez R, Mah YH, et al. A fast pathway for fear in human amygdala. Nat Neurosci. 2016;19(8):1041–9. https://doi.org/10.1038/nn.4324
Wilder-Smith EPV. Water immersion wrinkling: physiology and use as an indicator of sympathetic function. Clin Auton Res. 2004;14(2):125–31.
Kim BY, Oh BS, Park YK, Jang WC, Suh HJ, Im YH. Microinvasive video-assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis. Am J Surg. 2001;181(6):540–2. /das/journal/view/36919996-2/N/12595072?ja=301839&PAGE=1.html&ANCHOR=top&source=
Kux M. Thoracic endoscopic sympathicotomy in palmar and axillary hyperhidrosis. Arch Surg. 1978;113:264–6.
Adar R, Kurchin A, Zweig A, et al. Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Ann Surg. 1977;186:34–41.
Collin J. Treating hyperhidrosis surgery and botulinum toxin are treatments of choice in severe cases. BMJ. 2000;320:1221–2.
Johannes Z, Martin I, Erik RH, et al. Video assistance reduces complication rate of thoracoscopic sympathicotomy for hyperhidrosis. Ann Thorac Surg. 1999;68:1177–81.
Haan J, Mckaay AJ, Cuesta M, Rauwerda J. Posterior approach for the simultaneous, bilateral thoracoscopic sympathectomy. J Am Coll Surg. 2001;192(3):418–20. /das/journal/view/36919996-3/N/11742608?ja=318620&PAGE=1.html&ANCHOR=top&source=MI
Fredman B, Olsfanger D, Jedeikin R. Thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis anaesthetic implications. Br J Anaesth. 1997;79:113–9.
Kuhajda I, et al. Semi-Fowler vs. lateral decubitus position for thoracoscopic sympathectomy in treatment of primary focal hyperhidrosis. J Thorac Dis. 2015;7(S1):S5–S11.
Kuda T, Oshiro J, Nagamine N, et al. Comparison of thoracoscopic sympathectomy and sympathicotomy for primary palmar hyperhidrosis. Chest. 1998;114(suppl 4):S391–2.
Aydemir B, Imamoglu O, Ok T, Celik M. Sympathectomy versus sympathicotomy in palmar hyperhidrosis comparing T3 ablation. Thorac Cardiovasc Surg. 2015;63(8):715–9.
Lin M, Tu Y, Chen J, Li X, Lai F, Lin J. Efficacy comparison of two methods of r3 sympathicotomy for palmar hyperhidrosis. Zhonghua Yi Xue Za Zhi. 2014;94(47):3745–7.
Lee DY, Paik HC, Kim fazem H, Kim HW. Comparative analysis of T3 selective division of rami communicantes (ramicotomy) to T3 sympathetic clipping in treatment of palmar hyperhidrosis. Clin Auton Res. 2003;1:I45–7.
Hida K, Sakai T, Hayashi M, Tamagawa T, Abe Y. Sympathotomy para hiperhidrose palmar: os métodos de corte versus clamping. Clin Auton Res. 2015;25(5):271–6. https://doi.org/10.1007/s10286-015-0293-y. Epub 2015 14 de maio
Lin CC, Wu HH. T4-sympathetic endoscopic locking by clamping (ESB4) in the treatment of hyperhidrosis palmaris et axillaris - experiences of 165 cases. Ann Chir Gynaecol. 2001;90(3):167–9.
Choi BC, Lee YC. Sim SB. Treatment of palmar hyperhidrosis by endoscopic cut of the upper part of the sympathetic ganglion T4. Preliminary results. Clin Auton Res. 2003;Suppl 1:I48–51.
M I, Allam A. Comparing two methods of thoracoscopic sympathectomy for palmar hyperhidrosis. JAAPA. 2014;27(9):1–4.
Kuhajda I, Durie D, Koledin M, Ilic M. e cols. Electric vs. harmonic scalpel in treatment of primary focal hyperhidrosis with thoracoscopic sympathectomy. Ann Transl Med. 2015;3(15):211.
Divisi D, Di Leonardo G, De Vico A, Crisci R. Electrocautery versus Ultracision versus LigaSure in surgical management of hyperhidrosis. Thorac Cardiovasc Surg. 2015;63(8):729–34.
J C, Q D, M L, J L, X L, F L, Y T. Transareolar single port acute thoracic sympathectomy under intravenous anesthesia without intubation: a randomized controlled trial. J Laparoendosc Adv Surg Tech A. 2016;26(12):958–64.
Zhu LH, Chen W, Chen L, Yang S, Lu ZT. Transumbilical thoracic sympathectomy: a single-center trial of 148 cases with up to 4 years of follow-up. Eur J Cardiothorac Surg. 2016;49(Suppl 1):i79–83.
Chen JT, Liao CP, Chiang H, Wang B. Subxiphoid single-incision thoracoscopic bilateral ablative sympathectomy for hyperhidrosis. Interact Cardiovasc Thorac Surg. 2015;21:119–20.
H R, A R. Unilateral sympathectomy for primary palmar hyperhidrosis. Thorac Cardiovasc Surg. 2015;63(8):723–6.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
de Campos Werebe, E., Levischi, C., Sabbion, R. (2018). Surgical Techniques for the Realization of Thoracic Sympathectomy. In: Loureiro, M., Campos, J., Wolosker, N., Kauffman, P. (eds) Hyperhidrosis. Springer, Cham. https://doi.org/10.1007/978-3-319-89527-7_19
Download citation
DOI: https://doi.org/10.1007/978-3-319-89527-7_19
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-89526-0
Online ISBN: 978-3-319-89527-7
eBook Packages: MedicineMedicine (R0)