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Bilateral thoracoscopic sympathetic block by clipping.

Laureano Molins1, Juan J Fibla, José M Mier

  • 1Thoracic Surgery, Hospital Clinic and Hospital Universitari Sagrat Cor, Villarroel 170, Barcelona, Spain.

Multimedia Manual of Cardiothoracic Surgery : MMCTS
|January 14, 2014
PubMed
Summary

Sympathetic nerve clipping offers an effective alternative to sympathectomy for hyperhidrosis and facial blushing. This procedure shows similar or reduced compensatory sweating, with the potential for reversal.

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Area of Science:

  • Thoracic Surgery
  • Minimally Invasive Procedures
  • Autonomic Nervous System

Background:

  • Compensatory sweating (CS) is a primary cause of dissatisfaction following videothoracoscopic sympathectomy for hyperhidrosis (HH) and facial blushing (FB).
  • Standard sympathectomy provides symptom relief but can lead to significant CS.
  • Reversibility of the sympathetic block is desirable for managing intolerable CS.

Purpose of the Study:

  • To evaluate sympathetic nerve clipping as an alternative to sympathectomy for HH and FB.
  • To compare the efficacy, safety, and CS levels of nerve clipping versus sympathectomy.
  • To highlight the potential reversibility of sympathetic nerve clipping.

Main Methods:

  • Surgical procedure involves two 10 mm incisions for endoscopic access.

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  • A 30° camera and diathermy hook are used for visualization and manipulation.
  • Sympathetic nerves are identified, isolated, and clipped using an endoscopic clip applier.

    • Main Results:

    • Sympathetic nerve clipping demonstrates comparable efficacy and safety to sympathectomy.
    • CS levels are similar to or less than those observed with standard sympathectomy.
    • The technique offers theoretical reversibility by clip removal if CS is intolerable.

    Conclusions:

    • Sympathetic nerve clipping is a viable and potentially advantageous alternative to sympathectomy for HH and FB.
    • The procedure offers comparable outcomes with the added benefit of potential reversibility.
    • This technique may improve patient satisfaction by mitigating severe compensatory sweating.