Technical considerations in endoscopic cervicothoracic sympathectomy.

OBJECTIVE

To evaluate the technique and results of videoendoscopic cervicothoracic sympathectomy in patients who have reflex sympathetic dystrophy or hyperhidrosis of the upper extremity.

DESIGN

Clinical case series. The cohort underwent diagnostic evaluation and surgical intervention, and had a mean postoperative follow-up of 14 months.

SETTING

An urban, university-affiliated tertiary referral medical center.

PATIENTS: A consecutive, referred sample. Seven of the nine patients had reflex sympathetic dystrophy and two had bilateral upper extremity hyperhidrosis. Five were women and four were men, with a mean age of 44 years.

INTERVENTIONS: Ten thoracoscopic sympathectomies, encompassing the lower third of the stellate ganglion to the fourth thoracic ganglion, in nine patients. The technique is performed under general anesthesia, using three 1-cm incisions for instrument placement. Patients had bilateral hand temperature probes intraoperatively. Six of the procedures were in the left hemithorax, four in the right.

MAIN OUTCOME MEASURES: Relief of the symptoms for which the patient was referred. Perfection and alteration of the technique also were measured.

RESULTS

The average operating time was 91 minutes. The average length of hospital stay was 3.5 days. The mean increase in skin temperature was 2.4 degrees C. Nine of 10 patients had partial or complete relief of symptoms. One patient with severe dystrophic reflex sympathetic dystrophy has persistent symptoms. One patient had a pneumothorax for 48 hours. Horner's syndrome did not develop in any patient.

CONCLUSION

Endoscopic cervicothoracic sympathectomy is an effective, minimally invasive therapy for upper extremity reflex sympathetic dystrophy and hyperhidrosis.