The application of thoracoscopic sympathectomy for the optimal management of hyperhidrosis and severe upper extremity ischemia

The thoracic sympathectomy is traditionally performed through open surgical thoracotomy.It is an extensive procedure associated with an unacceptable inconvenience. The presentstudy describes a less morbid and minimally invasive thoracoscopy as the procedure ofchoice for thoracic sympathectomy. The present study, carried out during 2001 to 2005, was performed on 33 patientsaged from 17 to 18, with a mean of 42.7 years and comprising 25 males and 8 females. Theysuffered from essential hyperhidrosis and severe upper extremity ischemia, which were unsuitablefor 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 acutethrombosis, and 1 patient post-traumatic ischemia. The patients were indicated to undergo aprobable emergency thoracotomy. They were anaesthetized using one lung endobronchial intubationsand underwent a two-port videothoracoscopy. Sympathetic chain resection was limited toT2–T3 and lower third of the stellate ganglion. The patients were kept under careful observationand comparisons were made between their preoperative and postoperative symptoms. Moreover,the early and late complications were carefully documented and analyzed. The presenting symptoms included 11, 4, 4 and 3 cases of ulcer and gangrene, restpain, cyanosis and cold extremities, as well as excessive hand sweat respectively. The foregoingthoracic sympathectomy led to corresponding complete and partial recovery of 31 and 2 patients. Thoracoscopic sympathectomy is a simple, safe, reliable and cost effective therapywith surprisingly good results and low complications in patients with primary hyperhidrosis aswell as limb threatening upper extremity ischemia, an entity unsuitable for revascularization.Additionally, the results of sympathectomy