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Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results.

Cinà CS, Cinà MM, Clase CM - J Minim Access Surg (2007)

Bottom Line: We review the clinical features of hyperhidrosis and the range of treatments used for this condition.We summarize studies that have reported results of endoscopic sympathectomy.We present new data highlighting the difference in quality of life between patients with hyperhidrosis and controls.

View Article: PubMed Central - PubMed

Affiliation: Division of Vascular Surgery, Department of Surgery, University of Toronto and Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.

ABSTRACT

Outline: We review the clinical features of hyperhidrosis and the range of treatments used for this condition. We describe in detail the technique of endoscopic sympathectomy. We summarize studies that have reported results of endoscopic sympathectomy. We present new data highlighting the difference in quality of life between patients with hyperhidrosis and controls.

No MeSH data available.


Endoscopic view of the left hemithorax. The curly brackets delimitate the sympathetic chain. R = second rib; S = subclavian artery
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Figure 0004: Endoscopic view of the left hemithorax. The curly brackets delimitate the sympathetic chain. R = second rib; S = subclavian artery

Mentions: We perform bilateral ETS under general anesthesia using a single lumen endotracheal tube. Patients are positioned supine with both arms outstretched on arm boards and the trunk in a 30° Fowler position. The sterile field includes the neck, both axillae and upper arms down to the costal margin bilaterally [Figure 1]. A specifically designed and custom made 5 mm rigid scope is used [Figure 2]. This has a zero degree angle lens, an aspirating channel and an operating channel. The thoracoscope is introduced through a port placed in the mid-clavicular line in the second intercostal space. CO2 is insufflated to 8–10 cmH2O of pressure to collapse the dome of the lung. The thoracic chain is readily identified covered by the thin layer of the parietal pleura [Figures 3 and 4]. A diathermy hook is inserted through the operating channel of the thoracoscope. The sympathetic chain is visualized behind the parietal pleura, which is then scored on either side using the cautery to delineate the position of the chain and the extent of the planned cauterization which corresponds to the extent of the chain destroyed [Figures 5 and 6]. Using the ribs for reference, the sympathetic chain is then cauterized and divided from T2 to T3 for patients with predominantly palmar hyperhidrosis and from T2 to T4 for patients with predominantly axillary hyperhidrosis. The thoracoscope is then removed and replaced with a small red rubber catheter. With positive pressure ventilation, the catheter is then removed under suction to allow expansion of the lung. The skin incision is closed with a single absorbable 3–0 suture followed by placement of skin tapes. Contralateral sympathectomy is performed in a similar manner without changing the patient's position.


Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results.

Cinà CS, Cinà MM, Clase CM - J Minim Access Surg (2007)

Endoscopic view of the left hemithorax. The curly brackets delimitate the sympathetic chain. R = second rib; S = subclavian artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2749196&req=5

Figure 0004: Endoscopic view of the left hemithorax. The curly brackets delimitate the sympathetic chain. R = second rib; S = subclavian artery
Mentions: We perform bilateral ETS under general anesthesia using a single lumen endotracheal tube. Patients are positioned supine with both arms outstretched on arm boards and the trunk in a 30° Fowler position. The sterile field includes the neck, both axillae and upper arms down to the costal margin bilaterally [Figure 1]. A specifically designed and custom made 5 mm rigid scope is used [Figure 2]. This has a zero degree angle lens, an aspirating channel and an operating channel. The thoracoscope is introduced through a port placed in the mid-clavicular line in the second intercostal space. CO2 is insufflated to 8–10 cmH2O of pressure to collapse the dome of the lung. The thoracic chain is readily identified covered by the thin layer of the parietal pleura [Figures 3 and 4]. A diathermy hook is inserted through the operating channel of the thoracoscope. The sympathetic chain is visualized behind the parietal pleura, which is then scored on either side using the cautery to delineate the position of the chain and the extent of the planned cauterization which corresponds to the extent of the chain destroyed [Figures 5 and 6]. Using the ribs for reference, the sympathetic chain is then cauterized and divided from T2 to T3 for patients with predominantly palmar hyperhidrosis and from T2 to T4 for patients with predominantly axillary hyperhidrosis. The thoracoscope is then removed and replaced with a small red rubber catheter. With positive pressure ventilation, the catheter is then removed under suction to allow expansion of the lung. The skin incision is closed with a single absorbable 3–0 suture followed by placement of skin tapes. Contralateral sympathectomy is performed in a similar manner without changing the patient's position.

Bottom Line: We review the clinical features of hyperhidrosis and the range of treatments used for this condition.We summarize studies that have reported results of endoscopic sympathectomy.We present new data highlighting the difference in quality of life between patients with hyperhidrosis and controls.

View Article: PubMed Central - PubMed

Affiliation: Division of Vascular Surgery, Department of Surgery, University of Toronto and Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.

ABSTRACT

Outline: We review the clinical features of hyperhidrosis and the range of treatments used for this condition. We describe in detail the technique of endoscopic sympathectomy. We summarize studies that have reported results of endoscopic sympathectomy. We present new data highlighting the difference in quality of life between patients with hyperhidrosis and controls.

No MeSH data available.