Clinical experience in 397 consecutive thoracoscopic sympathectomies.
BACKGROUND
The purpose of this study is to evaluate the safety and efficacy of thoracoscopic sympathectomy for the treatment of hyperhidrosis, blushing, reflex sympathetic dystrophy, and digital ischemia.


METHODS
We conducted a retrospective review of 202 patients who underwent thoracoscopic sympathectomy at the University of Maryland from March 1992 to April 2003.


RESULTS
Three hundred ninety-seven procedures were performed on 202 patients (105 women, 97 men). Mean age was 29 years (range, 9 to 65). Indications for surgery included hyperhidrosis, facial blushing, digital ischemia, and reflex sympathetic dystrophy. Synchronous bilateral sympathectomies were performed in 194 patients; right side alone (n = 6); left side alone (n = 1); 1 patient had staged bilateral sympathectomies. Single incision with lung isolation technique was used. There was no mortality. Preoperative symptoms resolved completely or significantly improved in greater than 90% of patients. One patient with reflex sympathetic dystrophy recurred and 1 patient with hyperhidrosis complained of significant compensatory sweating. Compensatory sweating to a lesser degree occurred in approximately one third of patients. Complications included asymptomatic pleural effusion (n = 1), pneumothorax (n = 1), and reoperation for chylothorax that was identified early (n = 1). In 2 patients treated for facial blushing, Horner's syndrome developed postoperatively; 1 of them subsequently underwent blepharoplasty. In 3 patients, hyperesthesias developed at the incision.


CONCLUSIONS
Thoracoscopic sympathectomy can be performed safely and with excellent results. Compensatory sweating is the main side effect, although significant complaints from this are rare. Horner's syndrome remains an extremely uncommon complication as a result of thoracoscopic sympathectomy at our institution.
Kwong
King F
KF
Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. kkwong@smail.umaryland.edu
Cooper
Lindsay B
LB
Bennett
Leslie A
LA
Burrows
Whitney
W
Gamliel
Ziv
Z
Krasna
Mark J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D015142:Baltimore; D002648:Child; D002916:Chylothorax / Q000209:etiology; D005260:Female; D006732:Horner Syndrome / Q000209:etiology; D006801:Humans; D006941:Hyperesthesia / Q000209:etiology; D006945:Hyperhidrosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010996:Pleural Effusion / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome