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Video-assisted endoscopic thoracic ganglionectomy

D P Robertson1, R K Simpson, J E Rose

  • 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.

Journal of Neurosurgery
|August 1, 1993
PubMed
Summary
This summary is machine-generated.

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This study shows endoscopic thoracic ganglionectomy is a safe and effective treatment for palmar hyperhidrosis and reflex sympathetic dystrophy. The minimally invasive procedure offers quick recovery and excellent symptom relief for patients with upper extremity sympathetic nerve disorders.

Area of Science:

  • Neurosurgery
  • Minimally Invasive Surgery
  • Thoracic Surgery

Background:

  • Upper extremity sympathetic nerve disorders, such as palmar hyperhidrosis and reflex sympathetic dystrophy, are often treated with upper thoracic sympathectomy.
  • Traditional posterior approaches can be invasive; alternative endoscopic techniques have been described but often require specialized equipment.
  • There is a need for accessible, minimally invasive endoscopic methods for thoracic sympathectomy.

Purpose of the Study:

  • To describe and evaluate an endoscopic thoracic ganglionectomy technique using readily available laparoscopic equipment.
  • To assess the efficacy and safety of this endoscopic approach for treating palmar hyperhidrosis and reflex sympathetic dystrophy.

Main Methods:

  • Endoscopic thoracic ganglionectomy was performed on 30 patients (22 with palmar hyperhidrosis, 8 with reflex sympathetic dystrophy).

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  • The procedure involved accessing thoracic sympathetic ganglia (T-2 and T-3) via trocars and using specialized micro-scissors for dissection and excision.
  • Patients underwent double-lumen endotracheal intubation, CO2 insufflation for pneumothorax, and fiberoptic visualization.

    • Main Results:

    • The average hospital stay was 15.4 hours with no intraoperative complications and an average operating time of 30 minutes per side.
    • All patients with primary palmar hyperhidrosis experienced complete relief of symptoms.
    • 75% of patients with reflex sympathetic dystrophy reported complete or partial symptom relief after an average follow-up of 5 months.

    Conclusions:

    • Endoscopic thoracic ganglionectomy utilizing standard laparoscopic instruments is a well-tolerated and cost-effective alternative to posterior sympathectomy.
    • This minimally invasive technique provides excellent outcomes for both primary palmar hyperhidrosis and reflex sympathetic dystrophy.
    • The use of accessible instrumentation makes this a viable option for broader clinical application.