Endoscopic Thoracic Sympathectomy

Indications

• Indications include palmar hyperhidrosis, axillary hyperhidrosis, craniofacial hyperhidrosis and blushing, reflex sympathetic dystrophy, Raynaud disease, splanchnic pain, vascular insufficiency, angina pectoris, and heart arrhythmias such as long QT syndrome. The indication for which the results are most satisfactory is palmar hyperhidrosis.

• Patients undergoing thoracic sympathectomy should have previously completed and failed a trial of nonoperative therapy including topical therapy (primarily aluminum chloride hexahydrate [AlCl ₃ -6H ₂ O]) and iontophoresis, intradermal botulinum toxin injections, or glycopyrrolate.

• Thoracic sympathectomy may be performed via open approach or endoscopically with clip ligation of the sympathetic chain versus cauterization and sharp transection. Here we describe an endoscopic approach for clip ligation.