[Video-assisted thoracosopic sympathectomy: spectrum of indications and our own results (1995-1997)].

INTRODUCTION

Video-assisted thoracoscopic (VATS) sympathectomy is the most frequently used technique for surgical sympathectomy of the upper limbs. It has proven to be particularly effective in hyperhidrosis of the hands. The aim of this study is to review and discuss possible indications and analyse our own results from 1995 to 1997, including technical details on the use of a new 2-mm thoracoscope and instrumentation.

PATIENTS AND METHODS

Data of all 14 consecutive patients were prospectively assessed (8 females, 6 males, mean age 44 years; range 22-74 years). A total of 26 thoracoscopic sympathectomies were performed. Indications included: 7 cases of hyperhidrosis, 4 of inoperable and medically intractable angina pectoris, 3 of vascular diseases of the upper extremity. All patients were reexamined 3 months postoperatively and late follow-up was obtained in all patients, with a mean follow-up of 20 months postoperatively (4-36 months) by questionnaire.

RESULTS

22 Th2-Th5 and 4 Th2-Th4 resections of the sympathetic chain were performed. There was no conversion to open surgery. The mean operating time was 67 minutes (range 50-90 min.). One (3.8%) unilateral Horner syndrome occurred with complete recovery during follow up. Compensatory sweating occurred in 7 (50%). The mean hospitalisation was 4.7 days for all patients and 2.8 days for those with hyperhidrosis. In 10 patients (71.5%), symptoms of the underlying disease had completely ceased on the day of discharge, and in 4 (28.5%) the symptoms had improved. Two months postoperatively a unilateral relapse occurred in one patient with Raynaud's disease. After a mean of 20 months, the quality of life was improved in 12 (85%) and was unchanged as compared to preoperatively in 2 (15%).

CONCLUSIONS

Primary hyperhidrosis showed the best results after thoracoscopic sympathectomy. Although experience with angina pectoris is still limited, thoracoscopic sympathectomy seems to be a valuable alternative in otherwise inoperable cases. In upper-extremity vascular diseases the operation can be performed as a last therapeutic option, but relapse often occurs in these patients. 2-mm instrumentation decreases trauma and postoperative pain and improves cosmetic results, which obviously may play a role in younger patients with hyperhidrosis. Patients should be warned about compensatory sweating before thoracic sympathectomy.