Feasibility of endoscopic transesophageal thoracic sympathectomy (with video).
BACKGROUND
Thoracoscopic sympathectomy is the preferred surgical treatment for patients with disabling palmar hyperhidrosis. Current methods require a transthoracic approach to permit ablation of the thoracic sympathetic chain.


OBJECTIVE
To develop a minimally invasive, transesophageal endoscopic technique for a sympathectomy in a swine model.


METHODS
Nonsurvival animal study.


METHODS
Animal trial at a tertiary care academic center.


METHODS
This study involved 8 healthy Yorkshire swine.


METHODS
After insertion of a double-channel gastroscope, a Duette Band mucosectomy device was used to create a small esophageal mucosal defect. A short, 5-cm submucosal tunnel was created by using the tip of the endoscope and biopsy forceps. Within the submucosal space, a needle-knife was used to incise the muscular esophageal wall and permit entry into the mediastinum and chest. The sympathetic chain was identified at the desired thoracic level and was ablated or transected. The animals were killed at the completion of the procedure.


METHODS
Feasibility of endoscopic transesophageal thoracic sympathectomy.


RESULTS
The sympathetic chain was successfully ablated in 7 of 8 swine, as confirmed by gross surgical pathology and histology. In 1 swine, muscle fibers were inadvertently transected. On average, the procedure took 61.4+/-24.5 minutes to gain access to the chest, whereas the sympathectomy was performed in less than 3 minutes in all cases. One animal was killed immediately after sympathectomy, before the completion of the observation period, because of hemodynamic instability.


CONCLUSIONS
Nonsurvival series, animal study.


CONCLUSIONS
Endoscopic transesophageal thoracic sympathectomy is technically feasible, simple, and can be performed in a porcine model.
Turner
Brian G
BG
Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Gee
Denise W
DW
Cizginer
Sevdenur
S
Konuk
Yusuf
Y
Karaca
Cetin
C
Willingham
Field
F
Mino-Kenudson
Mari
M
Morse
Christopher
C
Rattner
David W
DW
Brugge
William R
WR
D000818:Animals; D004947:Esophagus / Q000601:surgery; D005240:Feasibility Studies; D006945:Hyperhidrosis / Q000601:surgery*; D023421:Models, Animal; D013552:Swine; D013562:Sympathectomy / Q000379:methods*; D013906:Thoracoscopy; D014741:Video Recording