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Transumbilical thoracic sympathectomy with an ultrathin flexible endoscope in a series of 38 patients

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Abstract

Background

The newest trend in the field of thoracic surgery, thoracic natural orifice transluminal endoscopic surgery (NOTES), is still in the early stages of development and limited to animal experiments. Transumbilical endoscopic surgery could work as a viable intermediate step before pure NOTES. We describe our experiences performing transumbilical–diaphragmatic thoracic sympathectomy with an ultrathin flexible endoscope for palmar and axillary hyperhidrosis in human patients.

Methods

From April 2010 to January 2012, a total of 38 patients underwent transumbilical–diaphragmatic thoracic sympathectomy. Through the incision in the umbilicus, a newly developed long trocar was inserted into the abdominal cavity. An ultrathin endoscope was introduced through the long trocar and then passed through the rigid incision made in the left and right diaphragm and into the thoracic cavity. The ganglion was ablated at the desired thoracic level.

Results

Sympathectomy was performed successfully in all patients. Mean operation time was 68 ± 16 (range, 48–107) minutes. There was no mortality and no conversion to open surgery during the operation of any patient. At a median follow-up of 11 (range, 4–12) months after surgery, no diaphragmatic hernia was observed. The rate of palmar hyperhidrosis and axillary hyperhidrosis resolution was 100 and 75 %, respectively.

Conclusions

Transumbilical endoscopic thoracic sympathectomy is technically feasible and safe, which has the possible advantages of pure NOTES and can be performed in routine clinical practice.

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Acknowledgments

Supported in part by the Key Project of Science and Technology of Fujian Province (Grant 2010I0011). The authors thank Professor Philip Wai Yan Chiu (Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong) for his critical review.

Disclosures

Li-Huan Zhu, Wen Wang, Shengsheng Yang, Dazhou Li, Zhijian Zhang, Shengping Chen, Xianjin Cheng, Long Chen, and Weisheng Chen have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, 350001, China

    Li-Huan Zhu, Shengsheng Yang, Shengping Chen, Xianjin Cheng, Long Chen & Weisheng Chen

  2. Department of Gastroenterology, Fuzhou General Hospital, Fujian Medical University, Fuzhou, 350001, China

    Wen Wang, Dazhou Li & Zhijian Zhang

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  1. Li-Huan Zhu
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  2. Wen Wang
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Correspondence to Long Chen or Weisheng Chen.

Additional information

Li-Huan Zhu and Wen Wang contributed equally to this study, and both should be considered first author.

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Zhu, LH., Wang, W., Yang, S. et al. Transumbilical thoracic sympathectomy with an ultrathin flexible endoscope in a series of 38 patients. Surg Endosc 27, 2149–2155 (2013). https://doi.org/10.1007/s00464-012-2732-3

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  • DOI: https://doi.org/10.1007/s00464-012-2732-3

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