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Hyperhidrosis pp 131-145 | Cite as

Surgical Techniques for the Realization of Thoracic Sympathectomy

  • Eduardo de Campos Werebe
  • Carlos Levischi
  • Rodrigo Sabbion
Chapter

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.

Keywords

Sympathectomy Eletrocautery Clip method Harmonic scalpel Resection of the chain 

References

  1. 1.
    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 CrossRefGoogle Scholar
  2. 2.
    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.Google Scholar
  3. 3.
    Changizi M, Weber R, Kotecha R, Palazzo J. Are wet-induced wrinkled fingers primate rain treads? Brain Behav Evol. 2011;77(4):286–90.CrossRefPubMedGoogle Scholar
  4. 4.
    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.PubMedPubMedCentralGoogle Scholar
  5. 5.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    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 CrossRefPubMedGoogle Scholar
  7. 7.
    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 CrossRefPubMedGoogle Scholar
  8. 8.
    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 CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    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 CrossRefPubMedGoogle Scholar
  11. 11.
    Wilder-Smith EPV. Water immersion wrinkling: physiology and use as an indicator of sympathetic function. Clin Auton Res. 2004;14(2):125–31.CrossRefPubMedGoogle Scholar
  12. 12.
    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= CrossRefPubMedGoogle Scholar
  13. 13.
    Kux M. Thoracic endoscopic sympathicotomy in palmar and axillary hyperhidrosis. Arch Surg. 1978;113:264–6.CrossRefPubMedGoogle Scholar
  14. 14.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Collin J. Treating hyperhidrosis surgery and botulinum toxin are treatments of choice in severe cases. BMJ. 2000;320:1221–2.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    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.CrossRefGoogle Scholar
  17. 17.
    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
  18. 18.
    Fredman B, Olsfanger D, Jedeikin R. Thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis anaesthetic implications. Br J Anaesth. 1997;79:113–9.CrossRefPubMedGoogle Scholar
  19. 19.
    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.PubMedPubMedCentralGoogle Scholar
  20. 20.
    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.Google Scholar
  21. 21.
    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.PubMedGoogle Scholar
  22. 22.
    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.PubMedGoogle Scholar
  23. 23.
    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.Google Scholar
  24. 24.
    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 maioCrossRefPubMedGoogle Scholar
  25. 25.
    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.PubMedGoogle Scholar
  26. 26.
    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.Google Scholar
  27. 27.
    M I, Allam A. Comparing two methods of thoracoscopic sympathectomy for palmar hyperidrosis. JAAPA. 2014;27(9):1–4.Google Scholar
  28. 28.
    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.PubMedPubMedCentralGoogle Scholar
  29. 29.
    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.CrossRefPubMedGoogle Scholar
  30. 30.
    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.CrossRefGoogle Scholar
  31. 31.
    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.PubMedGoogle Scholar
  32. 32.
    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.CrossRefPubMedGoogle Scholar
  33. 33.
    H R, A R. Unilateral sympathectomy for primary palmar hyperhidrosis. Thorac Cardiovasc Surg. 2015;63(8):723–6.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Eduardo de Campos Werebe
    • 1
  • Carlos Levischi
    • 1
  • Rodrigo Sabbion
    • 1
  1. 1.Hospital Israelita Albert EinsteinSão PauloBrazil

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