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Eur J Cardiothorac Surg 2002;21:67-70
© 2002 Elsevier Science NL

Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach

^a Division of Thoracic Surgery, University Hospital, Inselspital, Bern, Switzerland
^b Department of Surgery, University Hospital, CHUV, Lausanne, Switzerland

Received 10 July 2001; received in revised form 9 September 2001; accepted 10 October 2001.

* Corresponding author. Division of Thoracic Surgery, University Hospital of Zurich, CH 8090 Zurich, Switzerland. Tel.: +41-1-255-8802; fax: +41-1-255-8805
e-mail: didier.lardinois{at}chi.usz.ch

Objectives: This is a prospective study to evaluate the long-term outcome and the value of a transaxillary single port thoracic sympathectomy by use of a modified paediatric cystoresectoscope in a consecutive series of patients with facial blushing and/or hyperhidrosis. Materials and methods: All patients who underwent a thoracic transsection of the sympathetic chain from T2 to T5 by use of a 7-mm single port approach and a modified urologic electroresectoscope between 1996 and 1998 were prospectively analysed regarding postoperative morbidity and outcome (clinical evaluation, visual analogue scale) in order to validate this technique. Results: 37 patients (18 men, 19 women) with an age ranging from 18 to 67 years (mean 34 years) underwent 74 bilateral video-assisted thoracic sympathectomies. The indications for sympathectomy included facial blushing in 32%, hyperhidrosis in 52%, or both in 16% of the patients. Ninety-five percent of the patients were discharged from the hospital on the next day, the 30-day mortality was zero, and there was no conversion to an open procedure. A severe complication with crossed emboli and motor aphasia was noted. A unilateral transient Horner's syndrome was observed in two patients. Three-month follow-up revealed an excellent cosmetic and functional result, with no residual pain. Complete relief of symptoms was observed in 89% and in 100% of the patients with facial blushing and palmar hyperhidrosis, respectively, after a follow-up of 34.5 months. Recurrence of the symptoms after initial regression was noted in 5.7% of the patients 3 years after surgery. Compensatory sweating of the lower extremities was significantly increased in patients with hyperhidrosis and facial blushing; however, sweating of the trunk was only increased in patients with hyperhidrosis. Improvement of quality of life was observed in 94.6% of the patients. Conclusions: Single port thoracoscopic sympathectomy by use of a modified paediatric cystoresectoscope and transsection from T2 to T5 gives an excellent cosmetic and functional outcome, with better results in patients with hyperhidrosis.

Key Words: Single port sympathectomy • Paediatric cystoresectoscope • Facial blushing • Hyperhidrosis • Long-term clinical outcome

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