title: Feasibility of endoscopic transesophageal thoracic sympathectomy (with video).
abstract: 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.
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Turner
authors.forename: Denise W
authors.initials: DW
authors.lastname: Gee
authors.forename: Sevdenur
authors.initials: S
authors.lastname: Cizginer
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Konuk
authors.forename: Cetin
authors.initials: C
authors.lastname: Karaca
authors.forename: Field
authors.initials: F
authors.lastname: Willingham
authors.forename: Mari
authors.initials: M
authors.lastname: Mino-Kenudson
authors.forename: Christopher
authors.initials: C
authors.lastname: Morse
authors.forename: David W
authors.initials: DW
authors.lastname: Rattner
authors.forename: William R
authors.initials: WR
authors.lastname: Brugge
mesh_terms: 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