title: Technical considerations in endoscopic cervicothoracic sympathectomy.
abstract: OBJECTIVE
  To evaluate the technique and results of videoendoscopic cervicothoracic sympathectomy in patients who have reflex sympathetic dystrophy or hyperhidrosis of the upper extremity.
  
  
  METHODS
  Clinical case series. The cohort underwent diagnostic evaluation and surgical intervention, and had a mean postoperative follow-up of 14 months.
  
  
  METHODS
  An urban, university-affiliated tertiary referral medical center.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Endoscopic cervicothoracic sympathectomy is an effective, minimally invasive therapy for upper extremity reflex sympathetic dystrophy and hyperhidrosis.
authors.affiliation: Section of Vascular Surgery, Center of Minimal Access Surgery, Department of General Surgery, Boston University School of Medicine, Mass, USA.
authors.forename: L G
authors.initials: LG
authors.lastname: Josephs
authors.forename: J O
authors.initials: JO
authors.lastname: Menzoian
mesh_terms: D000328:Adult; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D015171:Ganglionectomy / Q000379:methods*; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012019:Reflex Sympathetic Dystrophy / Q000601:surgery*; D013233:Stellate Ganglion / Q000601:surgery*