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At least 433 records · Page 24Linked to original sources
PubMed1994

Endoscopic transthoracic sympathectomy: successful in hyperhidrosis but can the indications be extended?

Endoscopic transthoracic sympathectomy (ETS) has recently become established as a successful treatment for severe palmar and axillary hyperhidrosis. In this unit the indications for ETS have been broadened to include patients with Raynaud's syndrome and critical upper limb ischaemia and this paper is primarily concerned with analysing outcome in relation to the indication for operation. In all, 68 operations have been attempted in 40 patients and complete follow-up details are available on 62 treated limbs. One operation was a technical failure because of an obliterated pleural cavity. In the hyperhidrosis group (n = 28), all the affected areas showed symptomatic improvement at a median follow-up of 17 months. In the Raynaud's group (n = 30), 28 limbs (93%) were improved to some degree at the time of discharge, but at a median follow-up of 18 months only 15 limbs (50%) remained symtomatically improved to some degree. The four upper limbs treated for critical ischaemia were improved by ETS and no amputations were necessary. Significant postoperative chest pain was noted by nine patients (23%). There were three postoperative pneumothoraces, two intercostobrachial neuralgias and one transient Horner's syndrome. The cosmetic result was reported as excellent or good by 97% of patients. As with other forms of surgical thoracic sympathectomy, excellent early results are not maintained in the longer term when ETS is used to treat Raynaud's syndrome. Nevertheless, the greater simplicity and lower morbidity of the endoscopic method suggest that it can be offered to Raynaud's sufferers with greater impunity than open sympathectomies.

Adolescent↗
PubMed1994

Operative lumbar sympathectomy for severe lower limb ischaemia: still a valuable treatment option.

Over a 5-year period, 132 operative lumbar sympathectomies were performed on 118 patients with severe peripheral vascular disease unsuitable for vascular reconstruction. In 62 patients local ulcer débridement or toe amputation was performed at the same time. There was a 45% subsequent limb loss, which occurred predominantly in the first 6 months after sympathectomy. The risk of limb loss was independent of diabetes, hypertension, ischaemic heart disease, cerebrovascular disease or concomitant reconstructive surgery. Of the limbs that survived, rest pain had resolved in 86% within 6 months and 64% recovered from all trophic changes over a similar period. This series suggests that lumbar sympathectomy coupled with local tissue management remains a valuable treatment option for the severely ischaemic limb not amenable to reconstructive surgery.

Adult↗
PubMed1994

[Alternative one lung ventilation anesthesia for bilateral thoracoscopic sympathectomy].

Palmar hyperhidrosis (PH) is a common disorder in the oriental subtropical area. There have been many therapeutic methods, such as: oral medication, local treatment and traditional surgical operation, but none of them has proved entirely satisfactory. Since the development of video endoscopic surgery, transthoracic endoscopic sympathectomy has been increasing day by day. This study consisted of 124 PH patients under alternative one lung ventilation anesthesia for bilateral thoracoscopic laser sympathectomy. The age of patients ranged from 13 to 64 years, male 45 and female 79. The average anesthesia duration was 60 min. We used glycopyrrolate 0.03 mg/kg, decardon 1 mg/10 kg for premedication. Induction was with fentanyl 0.07 ml/kg, atracurium 0.6 mg/kg and thiopental 4 mg/kg. Maintenance was with isoflurane in 3L/min. oxygen inhalation. The alternative one lung ventilation anesthesia was achieved with double-lumen endobronchial tube. Fr 37, Fr 35, Fr 28 Sheridan Lt. double-lumen bronchial tube were used depending upon the sex and fudgement of the individual patient. All patients tolerated the procedure well so that sympathectomy could be performed smoothly and uneventfully. Immediately after the operation, a transient mild to moderate degree of difficult breathing and substernal discomfort were experienced in the majority of patients. These suffering often relieved spontaneously or with some common analgesic.

Adolescent↗
PubMed1993

Transaxillary endoscopic sympathectomy--a report of experience in 150 patients with palmar hyperhidrosis.

We report our 1-year experience with transaxillary endoscopic sympathectomy in 150 patients with palmar hyperhidrosis (PH). The double-puncture technique of video laparoscopy was used in a transaxillary approach to perform the sympathectomy by either electrocautery (EC; 93.3%) or electroresection (ER; 7.7%). The procedure was successfully completed in 299 operated limbs and required conversion to open surgery in 1 operated limb because of extensive pleural adhesions. The mean operative time of EC was significantly less than that of ER. In a total of 29 procedures, there were three technical complications. Most patients (92.7%) were discharged after an overnight hospital stay. On the seventh postoperative day, the cure rate was 99.3%. During the mean follow-up period of 200.1 days, there was no recurrence in 130 patients. Apparent compensatory hyperhidrosis occurred in 28 patients (21.5%). In conclusion, transaxillary endoscopic sympathectomy offers a simple and effective treatment to patients with PH, resulting in a shorter hospital stay and convalescent period.

Adolescent↗
PubMed1993

Video thoracoscopic dorsal sympathectomy: a new approach.

With the recent popularization of video laparoscopic cholecystectomy comes a renewed interest in thoracoscopy and its clinical applications in intrathoracic disease. Successful video thoracoscopic dorsal sympathectomy was accomplished in a patient with causalgia of the right upper extremity with immediate and complete resolution of pain and vasomotor symptoms. Standard operative approaches to dorsal sympathectomy are technically difficult, having risks of major nerve injury and Horner's syndrome. Video thoracoscopic dorsal sympathectomy obviates these risks and should become the procedure of choice in the future.

Adult↗
PubMed1977

[Lumbar sympathectomy for occlusion of thesuperficial femoral artery (author's transl)].

Lumbar sympathectomy is a good procedure for occlusion of the superficial femoral artery provided collateral circulation be stimulated by walking, and of course provided this circulation be intact. This requires an aortography which is necessary to arrive at a good prognosis. Lumbar sympathectomy without a previous aortogram is meaningless: it would lead to the ignorance of short stenoses of the internal iliac or deep femoral arteries and misinterpretation of the efficiency of lumbar sympathectomy.

Arterial Occlusive Diseases↗
PubMed1977

Indications and results of lumbar sympathectomy.

According to our experience the lumbar sympathectomy is not indicated for the treatment in clinical stage II. The best results for lumbar sympathectomy are to be expected in clinical stage III. We consider the protective sympathectomy combined with reconstructive arterial surgery indicate only in individual cases.

Arterial Occlusive Diseases↗
PubMed1977

[Experimental study of the sensitivity to catecholamines after lumbar sympathectomy (author's transl)].

To determine sensitivity to catecholamines after lumbar sympathectomy the authors first tested it in dogs : there was an increase in reactions to catecholamine beyond doubt after bilateral lumbar sympathectomy. In patients with arteritis they recorded, on a segment of the lower limb, a rheographic tracing with simultaneous modifications of the arterial blood pressure and electrocardiogram. These were studied after injection of adrenalin or noradrenalin in a dose of 5 to 7.5 mug (physiologic or stress level). Each of these tests were performed before and after lumbar sympathectomy.

Animals↗
PubMed1977

[Isotopic criteria for the assessment of the effects of lumbar sympathectomy (author's transl)].

The authors present a work intended to assess the effects of lumbar sympathectomy using radioactive microspheres. These contain 99mTe and are injected into the femoral artery. The distribution of radioactivity is then measured at the lower limb with a gamma camera linked to a computer. Seventeen patients were tested before and after lumbar sympathectomy. It appears from this short series that lumbar sympathectomy causes a redistribution of the radioactive material directed towards the extremities, mainly the feet.

Aged↗
PubMed1977

[Evaluation of the results of lumbar sympathectomy with functional vascular tests. Statistical study (author's transl)].

A series of 100 unselected patients operated on for lumbar sympathectomy were studied by digit plethysmography, thest of hyperemia, rheography, measurement of segmental pressure and dynamic tests, treadmill and Strandness test. Statistical analysis of data showed that isolated lesions of atheroma yield the best result. Increase in walking perimeter and in blood flow (rheographic quotient) were the only parameters showing statistical change. Forecasting of the effect of lumbar sympathectomy by the hyperemia test of Hillestad was confirmed. Other forms of disease : diffuse lesions, lesions of arteries in the legs or due to diabetes were followed by very numerous failures. Lumbar sympathectomy is justified as an isolate procedure for femoral lesions, and associated to reconstructive aorto-iliac surgery whenever the distal runoff consists only of a deep femoral artery.

Aged↗
PubMed1996

Thoracoscopic sympathectomy.

Thoracoscopic sympathectomy has become the most widely used approach to cervicothoracic sympathectomy. Appropriate selection of cases and a knowledge of the regional anatomy are essential in achieving good clinical results. The physiology and anatomy of the upper thoracic sympathectomy system and the indications, contraindications, and complications of the operation are described. The technique of the operation as done at the University of Virginia is then presented in a step-by-step manner.

Ganglia, Sympathetic↗
PubMed1996

Percutaneous radiofrequency upper thoracic sympathectomy.

Between June 1979 and May 1994, I performed 148 unilateral or bilateral sympathectomies on 247 limbs in 110 patients using a percutaneous radiofrequency technique, usually on an outpatient surgery basis. Patient ages ranged from 10 to 81 years, with 45 male and 65 female patients. Four patients had unsuccessfully undergone prior open surgical sympathectomy. Patients suffered from hyperhidrosis, vascular occlusion, Raynaud's disease or other chronic vasculopathies, painful causalgia or reflex sympathetic dystrophy, or Prinzmetal's angina. The sympathectomy technique has evolved over this 15-year period and is currently in its third phase. Changes in the procedure were based on anatomic and clinical/radiographic correlations and careful patient follow-up. Current modifications have reduced the frequency of both early and late failures. The present technique (Phase III) relies on neuroleptanalgesia with superficial local anesthesia only and does not require general anesthesia, intubation, or lung collapse. Two 18-gauge radiofrequency TIC needle electrodes (Radionics, Burlington, MA) are used. A series of three lesions is rostrocaudally made at each of the ganglion sites selected in an attempt to destroy the entire fusiform ganglion. Lesion sites are targeted by C-arm fluoroscopy and electrical stimulation, which produces a threshold of sensory awareness of > 1.0 V. Lesion effectiveness is monitored by bilateral finger plethysmography and hand skin temperature measurement. With the Phase III technique, the sympathetic activity in 96% of operated limbs after 2 years and in 91% of operated limbs after 3 years continues to be completely or largely interrupted. By comparison, I achieved similar success in 83 and 72% operated limbs with the Phase I technique and in 77 and 71% with the Phase II technique. Symptomatic pneumothorax, in six patients, has been the only serious complication. When necessary, a subsequent operation can easily be performed and is effective.

Adolescent↗
PubMed1996

In vivo effects of surgical sympathectomy on intramembranous bone resorption.

Bone modeling and remodeling are highly regulated processes in the mammalian skeleton. The exact mechanism by which bone can be modeled at a local site with little or no effect at adjacent anatomic sites is unknown. Disruption of the control of modeling within the temporal bone may lead to various bone disease such as otosclerosis, osteogenesis imperfecta, Paget's disease of bone, fibrous dysplasia, or the erosion of bone associated with chronic otitis media. One possible mechanism for such delicate control may be related to the ubiquitous and rich sympathetic innervation of all periosteal surfaces. Previous studies have indicated that regional sympathectomy leads to qualitative alterations in localized bone modeling and remodeling. In this study, unilateral cervical sympathectomy resulted in significant increases in osteoclast surface and osteoclast number within the ipsilateral bulla of experimental animals. The mechanisms by which sympathectomy leads to increased local bone loss is unknown. Potential mechanisms include disinhibition of resorption, secondary to the elimination of periosteal sympathetics, as well as indirect vascular effects.

Animals↗
PubMed1996

[Retroperitoneoscopic lumbar sympathectomy].

The development of revascularization techniques of the distal lower extremity dramatically diminished the need of lumbar sympathectomy. Which is indicated when patient with rest pain or with a profound gangrene of toes (which does not exceed the line of metatarsal articulation) could not be treated by vascular reconstruction. Lumbar sympathectomy could be done surgically or chemically, the efficiency of which is about 50%. The second to the fourth lumbar sympathetic ganglion could be resected with minimal invasivity, retroperitoneoscopically. This approach to lumbar sympathectomy opens further possibilities for operating in retroperitoneal space. Retroperitoneoscopy is well tolerated by patients.

Endoscopy↗
PubMed1996

Experience in thoracoscopic sympathectomy for hyperhidrosis with concomitant pleural adhesion.

Thoracoscopic (transthoracic endoscopic) sympathectomy, known worldwide as the best method for treatment of hyperhidrosis, is regarded as having two major contraindications: pleural adhesion and coagulopathy. We embarked on this study to prove that it is possible and highly feasible to do thoracoscopic sympathectomy, even in the presence of severe pleural adhesion, as long as the surgeon knows anatomy and is well-trained in performing this procedure. From October 1, 1989, through December 31, 1992, we treated 719 cases of hyperhidrosis palmaris (325 male and 394 female patients), by the thoracoscopic method at Tainan Municipal Hospital. Among them, 24 cases (3.5%), 19 male and 5 female patients, had concomitant pleural adhesions. The causes of pleural adhesion were pulmonary tuberculosis, chronic bronchitis, previous operations for hyperhidrosis, and a few with uncertain origins. Except for the first encountered case of hyperhidrosis with pleural adhesion, which was treated by mini-thoracotomy after failure of a thoracoscopic approach through the right thoracic cavity, the remainder of the 23 cases were treated successfully by the thoracoscopic method. In cases with bilateral pleural adhesions, the right thoracic cavity was more frequently involved and more severely. The incidence of pleural adhesion in hyperhidrosis is 3.5% in our series; all, except the first case, were treated thoracoscopically. Coagulopathy is for us, therefore, the only remaining contraindication of thoracoscopic sympathectomy.

Adolescent↗
PubMed1996

[Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis].

We report our initial experience, over the past 3 years, with thoracoscopic sympathectomy for severe, primary, palmar hyperhidrosis in children and adolescents. From 1992-1995, 179 thoracoscopic sympathectomies were performed in 61 girls and 35 boys, 5.5 to 18 years old (mean 14.8). During the first 2 years the procedures were performed bilaterally but not simultaneously. During the past years, 65 underwent bilateral, simultaneous sympathectomy, using a single 10 mm subaxillary port of entry. 94 (98%) had immediate and permanent relief of palmar sweating. The immediate postoperative course was uneventful in all except 2 who had residual pneumothorax that required 24-hour intercostal drainage. These results compare favorably with the open method and are actually better in terms of less pain, early discharge, quicker return to normal activity and a smaller and less conspicuous scar. We emphasize the benefits of early surgery in children with severe, palmer hyperhidrosis, to avoid the many years of psychological, social and physical discomfort during adolescent growth and development.

Adolescent↗
PubMed1997

Thoracoscopic sympathectomy for palmar hyperhidrosis. A case report.

Palmar hyperhidrosis is a disabling condition that manifests itself as excessive sweating of the hands. Although the exact cause is unknown, several medical and surgical therapies are available to treat it. Recent developments in surgical technique have made the less invasive thoracoscopic sympathectomy a viable alternative to the open sympathectomy for medically refractory cases. We believe that thoracoscopic sympathectomy is a safe and effective treatment for palmar hyperhidrosis.

Adult↗
PubMed1997

Laparoscopic transperitoneal lumbar sympathectomy: a new approach.

A report of five sympathectomies for the treatment of vasospastic symptoms of coldness, rest pain and trophic lesions at the affected feet. Three patients had a right-sided sympathectomy done and the other two had left-sided done via laparoscopic surgery. This report has advocated original techniques: Under general anesthesia, a patient is put into a lateral position with the table broken between the ribs and iliac crest. The telescope port is inserted horizontally at the edge of the rectus sheath in line with the umbilicus. Two secondary ports (5 mm, 10 mm) are inserted under direct vision in the midclavicular line. The peritoneal reflection lateral to the colon is incised down to the pelvic brim. The use of the lateral position facilitates medial displacement of the colon and the kidney by virtue of gravity. The L2, L3, L4 sympathetic ganglia are then doubly clipped and divided between clips. When such a small piece of the sympathetic trunk has been removed, a laparoscopic transperitoneal lumbar sympathectomy should be a very reasonable, safe, minimally invasive alternative to the traditional operation.

Adult↗