Drawbacks of endoscopic thoracic sympathectomy

Area of Science:

• Thoracic surgery
• Neurosurgery
• Medical device technology

Background:

• Endoscopic thoracic sympathectomy (ETS) is a common procedure for palmar hyperhidrosis and upper limb/head/neck conditions.
• Concerns exist regarding the safety profile of ETS.
• A comprehensive review of operative complications and long-term side effects is warranted.

Purpose of the Study:

• To review the operative complications associated with endoscopic thoracic sympathectomy (ETS).
• To evaluate the long-term side effects of ETS.
• To identify potential improvements in ETS safety and patient outcomes.

Main Methods:

• A systematic Medline search was conducted using relevant keywords: 'thoracoscopic sympathectomy', 'endoscopic thoracic sympathectomy', and 'complications'.
• References from identified articles were handsearched for additional relevant studies.
• The senior author's experience and personal communications were incorporated.

Main Results:

• No deaths directly attributed to ETS are reported in the literature, though nine anecdotal fatalities are known (bleeding, anesthesia).
• Significant intrathoracic bleeding occurs in up to 5% of patients, rarely requiring thoracotomy. Pneumothorax affects 2%, and rare instances of brain damage are documented.
• Compensatory hyperhidrosis is very common long-term, leading to regret in 1-2% of patients; Horner's syndrome is rare.

Conclusions:

• While ETS has risks, including bleeding and compensatory hyperhidrosis, improvements in instrumentation, training, and patient selection may mitigate these drawbacks.
• Careful patient selection and surgical technique are crucial for minimizing adverse events associated with ETS.
• The review underscores the importance of informed consent regarding potential complications like compensatory hyperhidrosis.