Thoracoscopic sympathectomy

The objective was to evaluate the safety and effectiveness of endoscopic th oracic sympathectomy (ETS) for treatment of a variety of sympathetic disord ers, including hyperhidrosis, splanchnic pain, reflex sympathetic dystrophy , and Raynaud upper extremity ischemia. Sixty-three ETS procedures were per formed in 34 patients at the University of Maryland Medical System between March 1992 and August 1999 (14 male patients, 20 female patients; mean age 22 years). The indications for surgery were hyperhidrosis in 26 patients, u pper extremity ischemia in 3 patients, splanchnic pain and reflex sympathet ic dystrophy in 2 patients each, and facial blushing in 1 patient. Preopera tive symptoms resolved completely or improved significantly in 97.1% (33/34 ) of patients. One patient with left reflex sympathetic dystrophy had sympt oms that recurred shortly after surgery. There were no major complications; one patient with hyperhidrosis reported significant compensatory hyperhidr osis, These findings suggest that ETS is a safe and effective procedure for treatment of a variety of sympathetic disorders. Its application for hyper hidrosis is very effective, and its treatment of splanchnic pain, reflex sy mpathetic dystrophy, and Raynaud syndrome ore rewarding. With increasing ex perience, ETS should become established in the repertoire of the thoracic s urgeon.