Posterior Bilateral Thoracodorsal Sympathectomy: Surgical Technique

Excerpt

Thoracoscopic sympathectomy has become the procedure of choice when surgical supression of thoracodorsal sympathetic activity is indicated. The treatment of severe upper extremity hyperhydrosis refractory to medical therapy is perhaps the most successful indication of thoracodorsal sympathectomy, and in our experience has proven to provide effective and durable cessation of excessive sweating.1 Hyperhydrosis involving the axillae and palms occurs bilaterally in most cases. Therefore, bilateral thoracodorsal sympathectomy is usually indicated in patients with hyperhydrosis. Patients with upper extremity hyperhydrosis are generally young and/or gainfully employed or attending school, thus it is important to minimize the disability involved in their treatment. For this reason, a bilateral intervention, rather than staged procedures, is advantageous in this patient population. We have developed and refined a video-assisted thoracoscopic technique for upper extremity sympathectomy using a posterior approach. Both sides can be done in a single operation, and the operation does not require double-lumen endotracheal intubation or unilateral lung collapse. The procedure is followed by an overnight hospital stay, carries a very low complication rate, and provides excellent results.1 …