THORACOSCOPIC CERVICODORSAL SYMPATHECTOMY - PRELIMINARY-RESULTS

Purpose: The purpose of this study was to determine the feasibility, s afety, and efficacy of thoracoscopic cervicodorsal sympathectomy. Meth ods: From March 1990 to December 1993, we performed 21 thoracoscopic s ympathectomies in 19 patients. There were 13 women and six men; age 17 to 64 years, mean 37 years. Thirteen procedures were performed on the left side and eight on the right. Indications for surgery were causal gia/reflex sympathetic dystrophy in nine patients, Raynaud's/vasculiti s in six, hyperhidrosis in five, and medically refractory cardiac arrh ythmia in one. Results: The T1-4 sympathetic ganglia were readily iden tified, dissected free, and resected thoracoscopically in 19 cases, an d the T3-7 ganglia were resected with thoracoscopy in one case. One ca se required conversion to an open thoracotomy because of dense scar fr om a previous first rib resection, which obscured the anatomy. Histolo gic confirmation of ganglia were obtained in all 21 cases. Operative d uration ranged from 1.0 to 3.5 hours. Estimated blood loss was 5 to 30 0 cc, mean 42 cc, median 10 cc. No patient required transfusion. Ah 21 patients had an excellent immediate sympathectomy response. Transient Horner's syndrome developed in two patients. Postoperative residual p neumothorax (<10%) occurred in three cases and resolved spontaneously without further treatment. In one patient pleural effusion and pneumot horax developed which were treated with the reinsertion of the chest t ube. Postoperative pain was well controlled with oral analgesics. Hosp ital stay was 1 to 4 days, mean 2 days, median 1 day. Follow-up at 1 t o 42 months, mean 11 months, median 6 months, showed continued evidenc e of sympathectomy effect in all patients, except one who died of her underlying disease 1 month after operation. Conclusions: We conclude t hat thoracoscopic sympathectomy is feasible, safe, and effective. Furt her studies are indicated to confirm its long-term benefits and to det ermine optimal thoracoscopic techniques.