Surgical Endoscopy

, Volume 27, Issue 8, pp 2868–2876 | Cite as

Right or left first during bilateral thoracoscopy?




Endoscopic thoracic sympathectomy (ETS) is now an established surgical technique for treatment of palmar hyperhidrosis that is performed under general anesthesia with positive pressure ventilation via either an endotracheal tube or a double lumen endobronchial tube. This is a bilateral disease that requires the division of the right and left thoracic sympathetic chain. The aim of this study was to compare the hemodynamic changes using a left capnothorax first versus right a capnothorax first surgical approach using a single lumen endotracheal tube in patients undergoing bilateral ETS. Lung collapse was achieved by carbon dioxide insufflation.


Forty patients of both sexes aged 18–30 years and of American Society of Anesthesiologists grade I were randomly assigned to undergo bilateral ETS. Patients were divided into two groups. Group L comprised left capnothorax first, followed by right capnothorax (n = 20). Group R comprised right capnothorax first, followed by left capnothorax (n = 20). The anesthesia technique was standardized for all patients. Cardiovascular variables were determined during the procedure every minute. Statistical analysis was performed by independent-sample t test and Pearson’s chi-square test.


There was a significant (P < 0.05) mean percentage decrease in systolic blood pressure in group L compared to group R. Similarly, the mean percentage decrease in diastolic blood pressure in group L was significant compared to group R (P < 0.05). Seven patients in group L developed bradycardia, but this was not found to be statistically significant.


When the left capnothorax first approach was used, there was significant hypotension, compared to a right capnothorax first thoracoscopy. We thus recommend that right capnothorax should be performed first in cases of bilateral ETS.


Blood pressure Capnothorax ETS Hyperhidrosis Sympathectomy Thoracoscopy 



Drs. Meera Kharbanda, Arun Prasad, and Ashish Malik have no conflicts of interest or financial ties to disclose.


  1. 1.
    Drott C (1994) The history of cervicothoracic sympathectomy. Eur J Surg 5:572–575Google Scholar
  2. 2.
    Harris RJD, Benveniste G, Pfitzner J (2002) Cardiovascular collapse caused by carbon dioxide insufflation during one lung anesthesia for thoracoscopic dorsal sympathectomy. Anaesth Intensive Care 30:86–89PubMedGoogle Scholar
  3. 3.
    Prasad A, Ali M, Kaul S (2010) Endoscopic thoracic sympathectomy for primary palmar hyperhidrosis. Surg Endosc 24(8):1952–1957PubMedCrossRefGoogle Scholar
  4. 4.
    Kellow NH, Scott AD, White SA, Feneck RO (1995) Comparison of the effects of propofol and isoflurane anesthesia on right ventricular function and shunt fraction during thoracic surgery. Br J Anaesth 75:578–582PubMedCrossRefGoogle Scholar
  5. 5.
    Jedeikin R, Olsfanger D, Schachor D, Mansoor K (1992) Anesthesia for transthoracic endoscopic sympathectomy in treatment of upper limb hyperhidrosis. Br J Anaesth 69:349–351PubMedCrossRefGoogle Scholar
  6. 6.
    Peden CJ, Prys-Roberts C (1993) Capnothorax: implications for anaesthetist. Anesthesia 48:664–666CrossRefGoogle Scholar
  7. 7.
    Grichnik KP, Dentz M, Lubarsky DA (1993) Hemodynamic collapse during thoracoscopy. J Cardiothorac Vasc Anesth 7:588–589PubMedCrossRefGoogle Scholar
  8. 8.
    Rozenburg B, Katz Y, Isserles SA, Baitman B (1996) Near-sitting position and two-lung ventilation for endoscopic transthoracic sympathectomy. J Cardiothorac Vasc Anesth 10:210–212CrossRefGoogle Scholar
  9. 9.
    Wolfer RS, Krasna MJ, Hasnain JU, McLaughlin JS (1994) Hemodynamic effects of carbon dioxide insufflations during thoracoscopy. Ann Thorac Surg 58:404–408PubMedCrossRefGoogle Scholar
  10. 10.
    Ohtsuka T, Imanaka K, Endoh M (1999) Hemodynamic effects of carbon dioxide insufflation under single lung ventilation during thoracoscopy. Ann Thorac Surg 68:29–33PubMedCrossRefGoogle Scholar
  11. 11.
    Bitto T, Mannion JD, Stephenson LW (1985) Pneumothorax during positive-pressure mechanical ventilation. J Thorac Cardiovasc Surg 89:585–591PubMedGoogle Scholar
  12. 12.
    Brock H, Rieger R, Gabreil C, Moosbauer W, Necek S (2000) Hemodynamic changes during thoracoscopic surgery: the effects of one-lung ventilation compared with carbon dioxide insufflation. Anesthesia 55:10–16CrossRefGoogle Scholar
  13. 13.
    Rutherford RB, Hurt HH, Brickman RD, Tubb JM (1968) The pathophysiology of progressive, tension pneumothorax. J Trauma 8:212–217PubMedCrossRefGoogle Scholar
  14. 14.
    El-Dawlatly AA, Al-Dohayan A, Samarkandi A, Algahdam F, Atef A (2001) Right vs left side thoracoscopic sympathectomy. Effects of CO2 insufflation on hemodynamics. Ann Chir Gynaecol 90:206–208PubMedGoogle Scholar
  15. 15.
    Gustman P, Yerger L, Wanner A (1983) Immediate cardiovascular effects of tension pneumothorax. Am Rev Respir Dis 127:171–174PubMedGoogle Scholar
  16. 16.
    Lin ES (2003) Physiology of the circulation. In: Pinnock C, Lin T, Smith T (eds) Fundamentals of anesthesia, 2nd edn. Greenwich Medical Media, London, pp 348–351Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of AnesthesiaApollo HospitalNew DelhiIndia
  2. 2.Department of Minimal Access SurgeryApollo HospitalNew DelhiIndia

Personalised recommendations