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What Is Thoracoscopic Sympathectomy?

Thoracoscopic sympathectomy resolves primary hyperhidrosis, Raynaud's phenomenon and excessive facial blushing. During the procedure, a surgeon partially disables the nerve that controls the sweat glands as well as the dilation of blood vessels near the surface of the skin of the face and fingers. Performed as a minimally invasive procedure, thoracoscopic sympathectomy has few risks, but people who undergo the surgery often experience later sweating problems in other parts of their bodies.

  1. About Primary Hyperhidrosis

    • People with primary hyperhidrosis sweat profusely from their armpits (axillae), hands and feet even when the air is cool and when they are not exerting themselves. Primary hyperhidrosis affects between 2 and 3 percent of the U.S. population and tends to run in families. The condition does not cause pain, but it can make sufferers uncomfortable and socially withdrawn.

    About Raynaud's Phenomenon

    • When people who experience Raynaud's phenomenon are exposed to cold temperatures or stressful situations, the skin of their ears, fingers, nose or ears turns white then blue. Primary Raynaud's phenomenon most often affects women younger than 30 years of age and occurs without a specific cause, such as blocked arteries (atherosclerosis) or past frostbite. As many as 5 percent of U.S. residents have the condition. Attacks of primary Raynaud's phenomenon usually do not cause pain or tingling.

    Procedure

    • During a thoracoscopic sympathectomy, a surgeon severs and seals the right-hand side of the sympathetic nerve, which runs along the inside of the spinal column. The nerve gets cut at a point parallel to the space between the second and third ribs. Most thoracoscopic sympathectomies are now performed as endoscopic procedures, in which the surgeon makes a small incision below the right armpit to access the sympathetic nerve and uses a flexible camera cable to guide the application of surgical instruments. Patients undergoing endoscopic thoracoscopic sympathectomy receive general anesthesia and must have their right lung deflated during the surgery, but patients generally do not need to stay in the hospital overnight. Full recovery occurs within a few days.

    Risks and Complications

    • Patients can expect some pain following a thoracoscopic sympathectomy. Also, an initial thoracoscopic sympathectomy does not always resolve a patient's problem, so a second procedure may be necessary. Rarer risks from the procedure include a collapsed lung caused by the collection of air in the chest cavity during surgery and inadvertent damage to other nerves near the sympathetic nerve. Some patients have developed Homer's syndrome following thoracoscopic sympathectomy, experiencing drooping eyelids, constricted pupils and reduced facial sweating.

    Prognosis

    • Thoracic surgeon Y. Rajesh and colleagues from the Royal Liverpool University Hospital investigated short- and long-term outcomes for 40 individuals who had undergone thoracoscopic sympathectomy. Writing in the November 2002 "Postgraduate Medical Journal," the U.K. researchers noted that all but 4 of the surveyed patients had their armpit sweating, blushing and skin tone problems resolved by thoracoscopic sympathectomy. However, 28 patients, or 77 percent of them, subsequently experienced uncontrolled sweating from their backs, chests or thighs. Another 8 patients (22 percent) began to sweat from their faces when they ate.

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