Effects Of Endoscopic Thoracic Sympathectomy Research Articles

Endoscopic Thoracic Sympathectomy for the Treatment of Hyperhidrosis

Background: Although hyperhidrosis is regarded as a benign sympathetic disorder, it can have a significant psychosocial impact on affected individuals while markedly affecting their quality of life (QoL). Objectives: We aimed to evaluate the effects of endoscopic thoracic sympathectomy (ETS) on the treatment of primary hyperhidrosis and patients’ QoL). Methods: This prospective interventional study included patients with primary hyperhidrosis referred to Shahid Mohammadi Hospital, Bandar Abbas, Iran, for ETS during 2012-2019. General characteristics including age, sex, and body mass index (BMI) were recorded for all patients. All participants underwent ETS by a single experienced surgeon. Patients were evaluated twice; once before the procedure and once one month after the procedure. The sites of hyperhidrosis, Hyperhidrosis Disease Severity Scale (HDSS), and QoL were the evaluated variables. Patients’ satisfaction, compensatory hyperhidrosis, and procedural complications such as pneumothorax were also assessed on follow-up. Results: From the 47 patients evaluated in this study with a mean ± SD age of 28.2±1.21 years, 27 (57.4%) were men. No patient experienced compensatory hyperhidrosis and procedural complications after the procedure. Also, 45 (95.7%) patients were 100% satisfied and 2 (4.3%) were 90% satisfied with the procedure. There was a significant reduction in the number of hyperhidrosis sites and HDSS score after one month compared with baseline (P=0.006 and P<0.001, respectively). Moreover, the QoL significantly improved after the procedure (P<0.001). Conclusion: ETS appears to be very safe and effective for the treatment of primary hyperhidrosis in terms of the reduction of hyperhidrosis sites and HDSS score, as well as improving QoL and patient satisfaction.

Effects of Endoscopic Thoracic Sympathectomy on Raynaud's Disease.

Raynaud's disease is a disorder that is characterized by attacks of pain, cyanosis, redness, and numbness in the upper extremities caused by vasospasm of digital arteries due to cold or emotional stress. We aimed at demonstrating our experiences with endoscopic thoracic sympathectomy (ETS) in the treatment of Raynaud's disease. From 48 patients who underwent ETS for various reasons at our department between January 2014 and January 2015, we reviewed 9 patients with Raynaud's disease (18.7%) with respect to their demographic characteristics such as gender and age, postoperative complications, short-term results, side effects, recurrence of symptoms, and long-terms results. The symptoms and findings reappeared and the number and dosage of the drugs used returned to their preoperative levels in 66.6% of the patients at month 6, and in all patients except 1 at the end of the 1st year. ETS should be considered an ultimate choice for patients with Raynaud's disease who have treatment-resistant severe symptoms and serious complications, disturbed social and daily lives, and impaired quality of life, and all patients should be properly informed before the surgery about the possibility of a high rate of recurrence.

Long-term results of endoscopic symphathetic block using the Lin-Telaranta classification

Endoscopic thoracic sympathectomy has been used successfully in the treatment of blushing, excessive sweating, and social phobia. However, the adverse effects of endoscopic thoracic sympathectomy are more severe and frequent than the adverse effects of endoscopic sympathetic block (ESB). The use of different blocking levels for different indications in ESB according to the Lin-Telaranta classification further decreases the postoperative adverse effects. However, there are few data on the long-term results of ESB performed using the Lin-Telaranta classification. Ninety-five patients (55 men, 40 women) were interviewed by before the surgery using our routine questionnaire, and the same questionnaire was answered postoperatively by the patients. In addition, a long-term follow-up questionnaire was sent to all patients whose address was known. Forty-seven patients (24 men, 23 women) answered to this questionnaire. The Davidson brief social phobia scale and the Liebowitz quality of life scale were used. Patients were divided to 3 categories: category 1, patients with sweating problems; category 2, patients with blushing; and category 3, and patients with symptoms other than sweating or blushing. Among patients in category 1, social phobia decreased from 12.43 to 6.71 (p=0.004), in category 2 from 13.97 to 7.69 (p<0.001), and in category 3 from 13.18 to 9.64 (p=0.007) during long-term follow-up. Among patients with severe sweating problems preoperatively, sweating decreased from 2.50 to 1.29 (p=0.003) among patients in category 1 and from 1.86 to 1.16 (p<0.001) among patients in category 2. Among patients with unbearable blushing, blushing decreased from 4 to 1.80 (p<0.001). Patients got a clear help from ESB performed using the Lin-Telaranta classification to treat blushing, excessive sweating, and social phobia with and without physical symptoms. In addition, compensatory sweating increased only slightly.

Effects of endoscopic thoracic sympathectomy for primary hyperhidrosis on cardiac autonomic nervous activity

Endoscopic thoracic sympathectomy is performed to treat primary hyperhidrosis. The second and third sympathetic thoracic ganglia excised also innervate the heart. Some studies have shown decreased heart rate but have not been conclusive regarding other cardiac effects of sympathectomy. We studied the cardiac autonomic effects of endoscopic thoracic sympathectomy in a group of patients with primary hyperhidrosis. Heart rate variability is a simple, noninvasive electrocardiographic marker reflecting the activity and balance of the sympathetic and vagal components of the autonomous nervous system. We performed a prospective study in 38 patients with primary hyperhidrosis with 24-hour Holter recordings obtained before endoscopic thoracic sympathectomy and 6 months later. We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity. These results provide, for the first time to our knowledge, clear evidence of increased vagal and global cardiac autonomic activity and decreased sympathetic activity after endoscopic thoracic sympathectomy.

Thoracic sympathectomy and cardiopulmonary responses to exercise

The purpose was to study the effect of endoscopic thoracic sympathectomy (ETS) for palmar and/or axillary hyperhidrosis on physiological responses at rest, and during sub-maximal and maximal exercise in ten healthy patients (7 females and 3 males 18-40 years old) with idiopathic palmar and/or axillary hyperhidrosis. T2-T3 thoracoscopic sympathectomy was performed using a simplified one stage bilateral procedure. Physiological variables were recorded at rest and during sub-maximal (steady-state) and maximal treadmill exercise immediately prior to and 70 days (+/-7.5, SD) after bilateral ETS. Exercise performance capacity and peak VO(2) were not found to be different following bilateral ETS than prior to the ETS. However, heart rate was significantly reduced at rest (14%), at sub-maximal exercise (12.3%), and at peak exercise (5.7%), together with a significant increase in oxygen pulse (11.8, 12.7, and 7.8%, respectively). The rate pressure product (RPP) was also significantly reduced following the surgical procedure at all three study stages, while all other physiological variables measured remained unchanged. It is suggested that thoracic-sympathetic denervation affects the heart, sweating, and circulation of the respective denervated region but does not affect exercise performance or mechanical/physiologic efficiency, despite a significant reduction in heart rate (both at rest and during exercise). The latter was, most likely, fully compensated by an increase in stroke volume and less likely by an improved muscle O(2) extraction due to more efficient blood distribution, keeping the work-rate and oxygen uptake unaffected.

Effect of Thoracic Sympathectomy on Exercise Tolerance and Cardio- Pulmonary Responses to Exercise

PURPOSE: Sympathetic denervation may limit exercise performance capacity by reducing cardiac output and/or by negatively affecting skeletal muscle metabolic behavior. To test this hypothesis, we studied the effect of endoscopic thoracic sympathectomy (ETS) for palmar and/or axillary hyperhidrosis on physiological responses at rest, and during submaximal and maximal exercise in 10 healthy patients (7 females and 3 males 18-40 years old) with idiopathic palmar and/or axillary hyperhidrosis. METHODS: T2-T3 thoracoscopic sympathicolysis was performed using a simplified one stage bilateral procedure. Physiological variables were recorded at rest and during sub-maximal (steady-state) and maximal treadmill exercise before and 70 (±7.5, SD) days after bilateral ETS. RESULTS: Palmar and/or axillary hyperhidrosis was relieved in every patient, confirming the T2- T3 denervation. After bilateral ETS exercise performance capacity (peak work rate reached) and peak VO2 were not different than prior to the ETS. However, heart rate was significantly reduced at rest 14%), at sub-maximal exercise (12.3%) and at peak exercise (5.7%) together with a significant increase in oxygen pulse (11.8%, 12.7% and 7.8%, respectively).The rate Pressure Product (RPP) was also significantly reduced following the surgical procedure at all three study stages. All other physiological variables measured remained unchanged during the three study's stages. CONCLUSIONS: It is suggested that sympathetic denervation of the upper limb do not affect exercise performance or mechanical/physiologic efficiency despite a significant reduction in heart rate (at rest and during exercise) which was, most likely, fully compensated by an increase in stroke volume and/or by an improved muscle O2 extraction and/or utilization (as indicated by the increased O2pulse), keeping the cardiac output and oxygen uptake unaffected.

Sympathectomy does not influence experimental itch and cutaneous temperature perception thresholds.

The effect of endoscopic thoracic sympathectomy on experimentally histamine-induced itch was studied in seven patients, all of whom were suffering from palmar hyperhidrosis; cutaneous warm, cold, and heat pain perception thresholds were also studied in five of these seven patients. Surgery was effective in abolishing palmar sweating in all patients. No significant differences were seen in itch, flare, wheal, or thermal perception thresholds following sympathectomy as compared to the preoperative period. These findings suggest that the sympathetic system may be of limited importance for somatosensory perception in healthy humans during normal conditions.