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Excision of Cervical Sympathetic Chain Thoracoscopic

  • Posted on- Apr 16, 2018
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Sympathectomy involves cauterizing and removing a portion of the sympathetic nerve chain T2-4 that runs down the back of the chest, parallel to the spine. This operation permanently interrupts the nerve signal that is causing the body to sweat excessively.

Starting on one side of the body, the anesthesiologist deflates the lung so that the surgeon will be able to get to the sympathetic nerve chain. He or she makes one or two small incisions underneath the armpit, usually between the second and third ribs.


The most common indications for cervical sympathectomy are focal hyperhidrosis, Raynaud's phenomenon and facial flushing accompanied by focal hyperhidrosis.

It can also be used to treat Bromhidrosis, although usually respond to non-surgical treatment, and sometimes with human olfactory reference syndrome surgeons may suggest sympathectomy.

There are reports of Endoscopic Thoracic Sympathectomy (ETS) used to achieve cerebral revascularization for individuals with moyamoya disease and the treatment of a headache, bronchial hyperactivity, with long QT syndrome, social phobia, anxiety and other conditions.

A small camera device called thoracoscope is placed through the incision in order to see inside the chest and identify the sympathetic nerve chain. Through the scope, a cautery device to cut and seal the appropriate level, as determined in advance by the patient's symptoms, is placed.

Patients with severe hyperhidrosis who have exhausted other medical treatments are finding that the thoracoscopic sympathectomy surgery offers a permanent solution to their problem.

In almost all cases, it cures excessive sweating in the hands and underarms, and many people experience the added benefit of decreased sweating in the feet.

Moreover, the effect of the surgery is often immediate. Patients are often amazed when they wake up and find their hands warm and dry for the first time in years.

The risks associated with the thoracoscopic sympathectomy procedure are minimal, but they need to be taken into account.

Many patients have reported experiencing side effects, either as a result of the procedure itself or from complications that may occur during the surgery.

Surgical Procedure

Endoscopic Thoracic Sympathectomy (ETS) involves dissecting the main sympathetic chain in the upper thoracic region of the sympathetic nervous system, which inevitably changes the neural messages that are likely to travel to many organs, glands and muscles.

It is through these nerves of the autonomic nervous system, the brain is able to make adjustments in the body in response to changing environmental conditions, mood changes, conditions of exercise and other factors to maintain homeostasis of the body.

Because these nerves also regulate conditions such as redness or excessive sweating, is a process designed to remove regulatory functions of these physiological mechanisms.

There is much disagreement among Endoscopic Thoracic Sympathectomy (ETS) surgeons about the best surgical method, the optimal location of nerve dissection, and the nature and extent of the primary and secondary effects resulting effects.

When performed endoscopically as is often the case, the surgeon penetrates the chest cavity to make more cuts around the diameter of a straw between ribs. This allows the surgeon to insert a camera (endoscope) into the hole and a surgical instrument to another.

The operation is performed dissection of the nervous tissue of the main sympathetic chain. Another technique, a method for fixing, also known as "endoscopic sympathetic block" (BSE) fastens the titanium towards the nerve to the muscle and was developed as an alternative to older methods, in a failed attempt to procedure reversible.

Technical reversal procedure tightening must be performed in a short period of time after pressing (estimated to be a few days or weeks at most), and the recovery, the evidence suggests, will not be complete.

Sympathectomy works by disabling part of the autonomic nervous system (and thus interrupts the signal from the brain) due to surgery, hoping to eliminate or mitigate the identified problem.

Many doctors consider the practice of Endoscopic Thoracic Sympathectomy (ETS) questionable, especially because its goal is to destroy functionally disordered nerves, but it is anatomically typical.

The accurate result of Endoscopic Thoracic Sympathectomy (ETS) is impossible to predict, due to the considerable anatomical variation in the function of the nerve from one to another, and also due to variations in surgical technique.

The autonomic nervous system is anatomically correct and possibly unpredictable connections are made when the nerves are disabled. This is demonstrated by the significant number of patients after sympathectomy on the same level of sweating hands, but the goal of reducing or eliminating sweat is introduced, unlike the other which is not affected so.

Thoracic sympathectomy distorts many bodily functions, including sweating, vascular reactions, heart rate, the stroke volume of the heart, thyroid, baroreceptorski reflex, lung volume, pupil dilation and others.

Reduces physiological response to strong emotions such as fear and laughter response, reduces the body's response to physical pain and pleasure, and inhibits skin sensations such as goose bumps.

Endoscopic Thoracic Sympathectomy (ETS) has some risks associated with it, such as bleeding, infection, conversion of open chest surgery and a number of specific risks, including constant and inevitable changes in nerve function.

It is reported that the number of patients -9 of 2010, many among the young ladies lost their lives during that process due to intrathoracic major bleeding and cerebral disorders.

Bleeding during and after surgery can be significant to 5% of patients. Pneumothorax (decreased lung) may occur (2% of patients). Compensatory hyperhidrosis (reflex or hyperhidrosis) is common in the long term, that is, according to a study for 1-2 percent of patients complain about experiencing this long-term impact. 

Among patients who developed this side effect, about a quarter in one survey said that is a big problem on and off. Thoracic sympathectomy possible serious consequences corposcindosis (syndrome split-body), in which the patient feels he or she lives in two separate bodies, because the function of the sympathetic nerve is divided into two different regions, one dead and the other hyperactive.

Long-term side effects include:

  • Changes in ultra-structural wall cerebral artery caused by long-term sympathetic denervation
  • Sympathectomy eliminates GSR
  • Cervical sympathectomy reduces the heterogeneity of oxygen saturation in venules cerebrocortical
  • Sympathetic denervation is one of the causes of multiple Mönckeberg
  • Heat stroke during exercise.
  • Morphofunctional changes in the myocardium following sympathectomy.


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