Thoracoscopic sympathicotomy

Thoracoscopy - Looking into the thoracic cavity was first described in 1910 by the Swedish physician, Jacobeus. He used a cystoscope intrapleuraly in order to diagnose pleural diseases. He also used his method for cutting adhesions in order to achieve collapse of the lung in patients with tuberculosis of the lung. Thoracic sympathicotomy was first performed by Kotzareff in 1920. The operation was found to be effective for treatment of palmar hyperhidrosis. Different open techniques for sympathicotomy have since been described, the most common being the dorsal approach by Cloward in 1969. Sympathicotomy was found to be effective not only for palmar, but also axillar hyperhidrosis, vascular insufficiency of the arm and hand, causalgia and angina pectoris (Lindgren 1950). However, the operation using the open technique was difficult and, though effective, not many patients were prepared to meet the demands for problems such as hyperhidrosis. Therefore, the operation became rather common. In the middle of the 1940's, several attempts were made to make the sympathicotomy through thoracoscopic approach and in 1951, Kux described a large number of patients treated in this way for many different diseases such as duodenal ulcer, diabetes mellitus, as well as the generally accepted indications. He published his experiences in a book; but for some obscure reason, his technique did not achieve general acceptance. In the late 1970's and the 1980's, the principle was again taken up by different centers (Byrnes, et. al.). I will describe here a technique which can be regarded as a simplification of previous methods. The technique was elaborated in our department and the first operation was performed in 1987 (Claes, et. al.). By June 1993, six hundred and seventy operations have been carried out.