Endoscopic transthoracic sympathectomy
Under the endoscopic transthoracic sympathectomy (ETS) is defined as the operational division of individual ganglia of the sympathetic nervous system for the treatment of excessive sweating ( hyperhidrosis ) or specific peripheral circulatory disorders.
indication
Today, ETS is a promising treatment method for hyperhidrosis of the armpits, hands or face. However, there are also critical voices, especially considering the possible complications, that recommend this operative solution only as a last resort. The tap water iontophoresis is just as successful; but requires lifelong regular treatments.
technology
General anesthesia is required for the operation .
The procedure is minimally invasive with special endoscopic instruments through one or more small incisions in the armpit and usually takes no longer than 30 minutes on either side of the body. In the chest cavity, one or more of the nerve ganglia along the vertebral bodies that stimulate the sweat glands are severed or interrupted using various techniques. The interruption with brackets is usually recommended because the operation remains reversible, i.e. reversible again. This makes sense if the compensatory sweating that always occurs is even more disadvantageous than the actual sweating before.
After an ETS, the patient can usually leave the hospital after a few days.
In Germany, the ETS is paid by the statutory health insurances (it is necessary for the patient to contact the health insurer before a planned operation in order to clarify the assumption of costs). A referral from a specialist (usually a dermatologist) for an outpatient presentation is sufficient.
Complications
- The Horner syndrome after erroneous violation of ganglion stellate leading to unilateral facial asymmetry with hanging eyelid.
- After a VATS (Video Assisted Thoracic Surgery), the temporary insertion of a chest tube is usually necessary in order to fully expand the lungs again. This can be waived in exceptional cases.
- Recurrent laryngeal nerve palsy ( vocal cord paralysis due to damage to the Recurrensnerven for vocal fold with hoarseness ), pleural effusion .
Possible consequences
So-called compensatory sweating often occurs . Compensatory sweating means the secretion of body sweat in other body regions. After an ETS, compensatory sweating often occurs over a large area on the back, stomach, buttocks, thighs or feet. Harlequin syndrome can rarely occur.
literature
- F. Vannucci, JA Araújo: Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results. In: Journal of thoracic disease. Volume 9, Suppl 3 April 2017, pp. S178 – S192, doi : 10.21037 / jtd.2017.04.04 , PMID 28446983 , PMC 5392541 (free full text) (review).
- JM Sternbach, MM DeCamp: Targeting the Sympathetic Chain for Primary Hyperhidrosis: An Evidence-Based Review. In: Thoracic surgery clinics. Volume 26, Number 4, November 2016, pp. 407-420, doi : 10.1016 / j.thorsurg.2016.06.005 , PMID 27692199 (Review), PDF .
- E. Moraites, OA Vaughn, S. Hill: Endoscopic thoracic sympathectomy. In: Dermatologic clinics. Volume 32, number 4, October 2014, pp. 541-548, doi : 10.1016 / j.det.2014.06.007 , PMID 25152348 (review), PDF .
- TA Ojimba, AE Cameron: Drawbacks of endoscopic thoracic sympathectomy. In: British Journal of Surgery . Volume 91, number 3, March 2004, pp. 264-269, doi : 10.1002 / bjs.4511 , PMID 14991624 (review), PDF .