[Minimally-invasive endoscopic transthoracic sympathectomy of the upper limbs. A new method].
OBJECTIVE
Indications for endoscopic transthoracic upper dorsal sympathectomy are axillary and palmar hyperhidrosis, upper extremities ischemia (due to, e.g., Raynaud s disease), and upper extremities causalgia.


METHODS
At present, this methodology relies on (at least) double trocar insertion (per side) and/or carbon dioxide insufflation. Thus, although this approach, compared with the traditional  open  sympathectomy techniques, it guarantees the smallest number of postoperative complications, it still determines a certain amount of postoperative discomfort as well as a risk of complications related to carbon dioxide insufflation, as intraoperative profound bradycardia and hypotension due to mediastinal shift, and postoperative subcutaneous emphysema. From December 1995, we are using a minimally-invasive endoscopic transthoracic sympathectomy technique, performed by a single-entry specifically modified thoracoscope and without the need for carbon dioxide insufflation, with the aim to reduce the drawbacks associated with the above-mentioned currently adopted endoscopic techniques. After general anesthesia with double-lumen endotracheal tube, with the patient placed in a half-sitting position with both arms abduced to 90 degrees, a 1 cm incision is performed, along the midclavear line (in male patients) or the anterior axillary line (in female patients), in the second or third intercostal space.


RESULTS
The effects of sympathectomy are immediate, and the patients wake up with warm and dry hands and axillae.


CONCLUSIONS
In personal opinion, this  single-entry  technique, compared with other reported approaches, should minimize any damage to the intercostal neurovascular bundle, while avoiding the complications connected with carbon dioxide insufflation.
Raposio
E
E
Istituto Nazionale per la Ricerca sul Cancro, Cattedra di Chirurgia Plastica, Università degli Studi, Genoa, Italy.
Filippi
F
F
Renzi
M
M
Caregnato
P
P
Capello
C
C
Santi
P L
PL
D001132:Arm / Q000294:innervation*; D002245:Carbon Dioxide / Q000008:administration & dosage; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D005728:Ganglia, Sympathetic / Q000601:surgery; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D007327:Insufflation; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D013562:Sympathectomy / Q000379:methods*; D013906:Thoracoscopy; D013997:Time Factors
D002245:Carbon Dioxide