Outpatient endoscopic thoracic sympathectomy using 2-mm instruments

For a long time it has been known that sympathectomy is an effective treatment for hyperhidrosis and other conditions. The surgical options available until recently usually have required thoracotomy or large posterior incisions, and physicians generally have been reluctant to recommend surgery for most patients with "benign" disorders. Recently, thoracoscopic techniques have allowed surgeons to offer these patients a permanent solution with minimal surgical trauma.

In 20 patients, 30 endoscopic thoracic sympathectomies (ETS) were performed for several indications. Nine patients had bilateral sympathectomies. The procedures were performed on the day of admission, with the patient under general anesthesia using double lumen endotracheal intubation and hand temperature monitoring. Each lung was reinflated on completion of the sympathectomy, and residual pneumothorax aspirated before closure of the incisions. No placement of chest tubes was performed in the operating room.

All sympathectomies were completed thoracoscopically. There were no major complications, and 90% of the patients were discharged within 24 hours of admission. The average operative time was 69 min.

Findings from this study show that ETS is a safe and effective procedure that can be performed routinely on an outpatient basis. The use of miniendoscopic (2-mm) instrumentation is safe and effective in most patients and a helpful adjunct in providing these patients with minimally traumatic surgery. Long-term results should be evaluated on the basis of specific indications for sympathectomy.