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Thoracoscopic Sympathectomy

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Abstract

Hyperhidrosis refers to pathologically excessive sweating which can be primary or secondary in nature. Primary focal hyperhidrosis has been estimated to affect 0.6–3 % of the population and can be truly disabling. Although some promote antiperspirants, botulinum toxin injections, or systemic anticholinergics, others promote thoracoscopic sympathectomy as early definitive treatment to avoid the embarrassment and potential withdrawal from society often plaguing these children. Thoracoscopic sympathectomy can be done in childhood, and long-term satisfaction has been shown to be highest when operating on children less than 14 years of age. Thoracoscopic sympathectomy is a safe procedure with high success rates and does not require advanced endoscopic skills though a clear understanding of the anatomy and steps of the procedure will prevent morbidity. The most common risk is compensatory hyperhidrosis, which seems less frequent in children. However, even with this complication, overall patient satisfaction remains high postoperatively. This chapter will focus on successful techniques for performing this procedure.

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References

  1. Hashmonai M, Kopelman D. History of sympathetic surgery. Clin Auton Res. 2003;13 Suppl 1:I6–9.

    PubMed  Google Scholar 

  2. Alexander W. The treatment of epilepsy. Edinburgh: Pentland; 1889.

    Google Scholar 

  3. Kotzareff A. Resection partielle du tronc sympathique cervical droit pour hyperhidrose unilaterate (regions faciale, cervicale, thoracique et brachiale droites). Rev Med Suisse Rom. 1920;40:111–3.

    Google Scholar 

  4. Hughes J. Endothoracic sympathectomy. Proc R Soc Med. 1942;35(9):585–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Kux M. Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis. Arch Surg. 1978;113(3):264–6.

    Article  CAS  PubMed  Google Scholar 

  6. Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol. 2004;51(2):274–86.

    Article  PubMed  Google Scholar 

  7. Strutton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol. 2004;51(2):241–8.

    Article  PubMed  Google Scholar 

  8. Adar R, Kurchin A, Zweig A, Mozes M. Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Ann Surg. 1977;186(1):34–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Li X, Chen R, Tu YR, Lin M, Lai FC, Li YP, et al. Epidemiological survey of primary palmar hyperhidrosis in adolescents. Chin Med J. 2007;120(24):2215–7.

    PubMed  Google Scholar 

  10. Ro KM, Cantor RM, Lange KL, Ahn SS. Palmar hyperhidrosis: evidence of genetic transmission. J Vasc Surg. 2002;35(2):382–6.

    Article  PubMed  Google Scholar 

  11. Altman RS, Schwartz RA. Emotionally induced hyperhidrosis. Cutis. 2002;69(5):336–8.

    PubMed  Google Scholar 

  12. Drott C, Gothberg G, Claes G. Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis. J Am Acad Dermatol. 1995;33(1):78–81.

    Article  CAS  PubMed  Google Scholar 

  13. Cerfolio RJ, De Campos JR, 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.

    Article  PubMed  Google Scholar 

  14. Vazquez LD, Staples NL, Sears SF, Klodell CT. Psychosocial functioning of patients after endoscopic thoracic sympathectomy. Eur J Cardiothorac Surg. 2011;39(6):1018–21.

    Article  PubMed  Google Scholar 

  15. Gelbard CM, Epstein H, Hebert A. Primary pediatric hyperhidrosis: a review of current treatment options. Pediatr Dermatol. 2008;25(6):591–8.

    Article  PubMed  Google Scholar 

  16. Baumgartner FJ, Bertin S, Konecny J. Superiority of thoracoscopic sympathectomy over medical management for the palmoplantar subset of severe hyperhidrosis. Ann Vasc Surg. 2009;23(1):1–7.

    Article  PubMed  Google Scholar 

  17. Wang YC, Sun MH, Lin CW, Chen YJ. Anatomical location of T2-3 sympathetic trunk and Kuntz nerve determined by transthoracic endoscopy. J Neurosurg. 2002;96(1 Suppl):68–72.

    PubMed  Google Scholar 

  18. Schiller Y. The anatomy and physiology of the sympathetic innervation to the upper limbs. Clin Auton Res. 2003;13 Suppl 1:I2–5.

    PubMed  Google Scholar 

  19. Yarzebski JL, Wilkinson HA. T2 and T3 sympathetic ganglia in the adult human: a cadaver and clinical-radiographic study and its clinical application. Neurosurgery. 1987;21(3):339–42.

    Article  CAS  PubMed  Google Scholar 

  20. Ramsaroop L, Singh B, Moodley J, Partab P, Satyapal KS. Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era. Clin Anat. 2004;17(4):294–9.

    Article  CAS  PubMed  Google Scholar 

  21. Kuntz A. Distribution of the sympathetic rami to the brachial plexus: its relation to sympathectomy affecting the upper extremity. Arch Surg. 1927;15(6):871–7.

    Article  Google Scholar 

  22. Singh B, Moodley J, Ramdial PK, Ramsaroop L, Satyapal KS. Pitfalls in thoracoscopic sympathectomy: mechanisms for failure. Surg Laparosc Endosc Percutan Tech. 2001;11(6):364–7.

    Article  CAS  PubMed  Google Scholar 

  23. Ramsaroop L, Partab P, Singh B, Satyapal KS. Thoracic origin of a sympathetic supply to the upper limb: the ‘nerve of Kuntz’ revisited. J Anat. 2001;199(Pt 6):675–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Liu Y, Yang J, Liu J, Yang F, Jiang G, Li J, et al. Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy. Eur J Cardiothorac Surg. 2009;35(3):398–402.

    Article  PubMed  Google Scholar 

  25. Chang YT, Li HP, Lee JY, Lin PJ, Lin CC, Kao EL, et al. Treatment of palmar hyperhidrosis: T(4) level compared with T(3) and T(2). Ann Surg. 2007;246(2):330–6.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Munia MA, Wolosker N, Kauffman P, de Campos JR, Puech-Leao P. A randomized trial of T3-T4 versus T4 sympathectomy for isolated axillary hyperhidrosis. J Vasc Surg. 2007;45(1):130–3.

    Article  PubMed  Google Scholar 

  27. Chou SH, Kao EL, Lin CC, Chang YT, Huang MF. The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464 cases. Surg Endosc. 2006;20(11):1749–53.

    Article  PubMed  Google Scholar 

  28. Wolfer RS, Krasna MJ, Hasnain JU, McLaughlin JS. Hemodynamic effects of carbon dioxide insufflation during thoracoscopy. Ann Thorac Surg. 1994;58(2):404–7. discussion 7–8.

    Article  CAS  PubMed  Google Scholar 

  29. Krasna MJ. Thoracoscopic sympathectomy: a standardized approach to therapy for hyperhidrosis. Ann Thorac Surg. 2008;85(2):S764–7.

    Article  PubMed  Google Scholar 

  30. Yanagihara TK, Ibrahimiye A, Harris C, Hirsch J, Gorenstein LA. Analysis of clamping versus cutting of T3 sympathetic nerve for severe palmar hyperhidrosis. J Thorac Cardiovasc Surg. 2010;140(5):984–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hynes CF, Yamaguchi S, Bond CD, Marshall MB. Reversal of sympathetic interruption by removal of clips. Ann Thorac Surg. 2015;99(3):1020–3.

    Article  PubMed  Google Scholar 

  32. Chung IH, Oh CS, Koh KS, Kim HJ, Paik HC, Lee DY. Anatomic variations of the T2 nerve root (including the nerve of Kuntz) and their implications for sympathectomy. J Thorac Cardiovasc Surg. 2002;123(3):498–501.

    Article  PubMed  Google Scholar 

  33. Gossot D, Toledo L, Fritsch S, Celerier M. Thoracoscopic sympathectomy for upper limb hyperhidrosis: looking for the right operation. Ann Thorac Surg. 1997;64(4):975–8.

    Article  CAS  PubMed  Google Scholar 

  34. Kim DH, Hong YJ, Hwang JJ, Kim KD, Lee DY. Topographical considerations under video-scope guidance in the T3,4 levels sympathetic surgery. Eur J Cardiothorac Surg. 2008;33(5):786–9.

    Article  PubMed  Google Scholar 

  35. Reisfeld R. Azygos lobe in endoscopic thoracic sympathectomy for hyperhidrosis. Surg Endosc. 2005;19(7):964–6.

    Article  CAS  PubMed  Google Scholar 

  36. Kauffman P, Wolosker N, de Campos JR, Yazbek G, Jatene FB. Azygos lobe: a difficulty in video-assisted thoracic sympathectomy. Ann Thorac Surg. 2010;89(6):e57–9.

    Article  PubMed  Google Scholar 

  37. Sinha CK, Kiely E. Thoracoscopic sympathectomy for palmar hyperhidrosis in children: 21 years of experience at a tertiary care center. Eur J Pediatr Surg. 2013;23(6):486–9.

    Article  CAS  PubMed  Google Scholar 

  38. Herbst F, Plas EG, Fugger R, Fritsch A. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and long-term results of 480 operations. Ann Surg. 1994;220(1):86–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Gossot D, Galetta D, Pascal A, Debrosse D, Caliandro R, Girard P, et al. Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann Thorac Surg. 2003;75(4):1075–9.

    Article  PubMed  Google Scholar 

  40. Yazbek G, Wolosker N, de Campos JR, Kauffman P, Ishy A, Puech-Leao P. Palmar hyperhidrosis--which is the best level of denervation using video-assisted thoracoscopic sympathectomy: T2 or T3 ganglion? J Vasc Surg. 2005;42(2):281–5.

    Article  PubMed  Google Scholar 

  41. Wolosker N, de Campos JR, Kauffman P, de Oliveira LA, Munia MA, Jatene FB. Evaluation of quality of life over time among 453 patients with hyperhidrosis submitted to endoscopic thoracic sympathectomy. J Vasc Surg. 2012;55(1):154–6.

    Article  PubMed  Google Scholar 

  42. Steiner Z, Cohen Z, Kleiner O, Matar I, Mogilner J. Do children tolerate thoracoscopic sympathectomy better than adults? Pediatr Surg Int. 2008;24(3):343–7.

    Article  PubMed  Google Scholar 

  43. Neves S, Uchoa PC, Wolosker N, Munia MA, Kauffman P, de Campos JR, et al. Long-term comparison of video-assisted thoracic sympathectomy and clinical observation for the treatment of palmar hyperhidrosis in children younger than 14. Pediatr Dermatol. 2012;29(5):575–9.

    Article  PubMed  Google Scholar 

  44. Bell D, Jedynak J, Bell R. Predictors of outcome following endoscopic thoracic sympathectomy. ANZ J Surg. 2014;84(1–2):68–72.

    Article  PubMed  Google Scholar 

  45. Sugimura H, Spratt EH, Compeau CG, Kattail D, Shargall Y. Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility. J Thorac Cardiovasc Surg. 2009;137(6):1370–6. discussion 6–7.

    Article  PubMed  Google Scholar 

  46. Bryant AS, Cerfolio RJ. Satisfaction and compensatory hyperhidrosis rates 5 years and longer after video-assisted thoracoscopic sympathotomy for hyperhidrosis. J Thorac Cardiovasc Surg. 2014;147(4):1160–3. e1.

    Article  PubMed  Google Scholar 

  47. de Campos JR, Kauffman P, Werebe Ede C, Andrade Filho LO, Kusniek S, Wolosker N, et al. Quality of life, before and after thoracic sympathectomy: report on 378 operated patients. Ann Thorac Surg. 2003;76(3):886–91.

    Article  PubMed  Google Scholar 

  48. Ahn SS, Machleder HI, Concepcion B, Moore WS. Thoracoscopic cervicodorsal sympathectomy: preliminary results. J Vasc Surg. 1994;20(4):511–7. discussion 7–9.

    Article  CAS  PubMed  Google Scholar 

  49. Kopelman D, Hashmonai M, Ehrenreich M, Bahous H, Assalia A. Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis: improved intermediate-term results. J Vasc Surg. 1996;24(2):194–9.

    Article  CAS  PubMed  Google Scholar 

  50. Inbar O, Leviel D, Shwartz I, Paran H, Whipp BJ. Thoracic sympathectomy and cardiopulmonary responses to exercise. Eur J Appl Physiol. 2008;104(1):79–86.

    Article  PubMed  Google Scholar 

  51. Noppen M, Dendale P, Hagers Y, Herregodts P, Vincken W, D’Haens J. Changes in cardiocirculatory autonomic function after thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis. J Auton Nerv Syst. 1996;60(3):115–20.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. General Surgery, Beaumont Health, Royal Oak, MI, USA

    Wesley Barnes & Zachary Hothem

  2. Pediatric Surgery, Beaumont Children’s – Beaumont Health, Oakland University William Beaumont School of Medicine, 3535 W. 13 Mile Road, Suite 307, Royal Oak, MI, 48126, USA

    Nathan Novotny

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  1. Wesley Barnes
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  2. Zachary Hothem
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  3. Nathan Novotny
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Correspondence to Nathan Novotny .

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Editors and Affiliations

  1. Division of Pediatric Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA

    Danielle S. Walsh

  2. Northeast Ohio Medical College Division of Pediatric Surgery, Akron Children’s Hospital, Akron, Ohio, USA

    Todd A. Ponsky

  3. Division of Pediatric Surgery, Akron Children’s Hospital, Akron, Ohio, USA

    Nicholas E. Bruns

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Barnes, W., Hothem, Z., Novotny, N. (2017). Thoracoscopic Sympathectomy. In: Walsh, D., Ponsky, T., Bruns, N. (eds) The SAGES Manual of Pediatric Minimally Invasive Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-43642-5_9

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  • DOI: https://doi.org/10.1007/978-3-319-43642-5_9

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