Author/Authors :
Modaghegh, H Mashhad Vascular Surgery Research Center - Department of Vascular Surgery - Mashhad University of Medical Sciences, Mashhad , Kazemzadeh, GH Mashhad Vascular Surgery Research Center - Department of Vascular Surgery - Mashhad University of Medical Sciences, Mashhad , Ravari, H Mashhad Vascular Surgery Research Center - Department of Vascular Surgery - Mashhad University of Medical Sciences, Mashhad
Abstract :
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.
Keywords :
Hyperhidrosis , Ischemia , Thoracoscopy , Sympathectomy
