Technical considerations in endoscopic cervicothoracic sympathectomy
L. G. Josephs and J. O. Menzoian
Section of Vascular Surgery, Center of Minimal Access Surgery, Department of General Surgery, Boston University School of Medicine, Mass, USA.
OBJECTIVE: To evaluate the technique and results of videoendoscopic
cervicothoracic sympathectomy in patients who have reflex sympathetic
dystrophy or hyperhidrosis of the upper extremity. DESIGN: Clinical case
series. The cohort underwent diagnostic evaluation and surgical
intervention, and had a mean postoperative follow-up of 14 months. SETTING:
An urban, university-affiliated tertiary referral medical center. PATIENTS:
A consecutive, referred sample. Seven of the nine patients had reflex
sympathetic dystrophy and two had bilateral upper extremity hyperhidrosis.
Five were women and four were men, with a mean age of 44 years.
INTERVENTIONS: Ten thoracoscopic sympathectomies, encompassing the lower
third of the stellate ganglion to the fourth thoracic ganglion, in nine
patients. The technique is performed under general anesthesia, using three
1-cm incisions for instrument placement. Patients had bilateral hand
temperature probes intraoperatively. Six of the procedures were in the left
hemithorax, four in the right. MAIN OUTCOME MEASURES: Relief of the
symptoms for which the patient was referred. Perfection and alteration of
the technique also were measured. RESULTS: The average operating time was
91 minutes. The average length of hospital stay was 3.5 days. The mean
increase in skin temperature was 2.4 degrees C. Nine of 10 patients had
partial or complete relief of symptoms. One patient with severe dystrophic
reflex sympathetic dystrophy has persistent symptoms. One patient had a
pneumothorax for 48 hours. Horner's syndrome did not develop in any
patient. CONCLUSION: Endoscopic cervicothoracic sympathectomy is an
effective, minimally invasive therapy for upper extremity reflex
sympathetic dystrophy and hyperhidrosis.
