Introduction
Thoracic sympathectomy is the treatment of the choice for limb illnesses, including Raynaud's disease, axillary or palmar hyperhidrosis, and peripheral vascular disease. Numerous surgical approaches and techniques have been described but the endoscopic thoracic sympathectomy has been proven to be the least invasive method with success rates. Endoscopic procedures have the benefit of providing a clear view of the neck during the surgery. Compensatory and gustatory sweating is the most common complaint of patients after surgery. In this article, we will discuss the side effects of endoscopic thoracic sympathectomy in our patients because methods for treating these diseases have included open surgical and endoscopic procedures. The patients who underwent the thoracic sympathectomy considered immediate complications during surgery and long hospital stay.
What Is Endoscopic Thoracic Sympathectomy?
Endoscopic thoracic sympathectomy (ETS) is a surgical procedure in which a portion of the sympathetic nerve chain is cut or removed from the chest cavity. This is done to treat excessive sweating (hyperhidrosis), blushing, or other conditions related to overactive sympathetic nerves.
What to Expect Before Endoscopic Thoracic Sympathectomy?
If someone is scheduled to undergo endoscopic thoracic sympathectomy (ETS), it is important to understand what to expect during the procedure. The following is the general outline of what typically happens during ETS:
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Pre-operative Preparation: Before the surgery, the patient will be asked to fast for a certain period. The patient may also be asked to stop taking certain medications that can affect bleeding, such as aspirin or blood thinners. The patient will be given general anesthesia to make them unconscious during the procedure.
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Incision and Insertion of the Endoscope: The surgeon will make small incisions on the chest wall and insert a small tube with a camera and surgical instruments called an endoscope. In doing so, the surgeon will be able to view the chest cavity and locate the targeted sympathetic nerves.
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Closure of Incisions: The incisions will be stitched up once the object has been removed.
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Recovery: The patient will be brought to a recovery area where they will be kept under observation for some time. Most patients can return home either that day or the next. day after the procedure.
What Are the Indications of Endoscopic Thoracic Sympathectomy?
The following are the indications of endoscopic thoracic sympathectomy:
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Hyperhidrosis - The condition in which excessive sweating occurs is called hyperhidrosis. ETS is indicated for patients with inherent palmer hyperhidrosis (patients who are suffering from excessive sweating from the limbs). The patients who are suffering from hyperhidrosis affected their quality of life and it also interferes with their social functioning. ETS is considered if other conservative treatments (drug therapy, aluminum chloride, iontophoresis, stellate ganglion block, botulin injection to the palm) are inadequate.
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Neuropathic Pain in the Upper Limbs - ETS may be performed to relieve symptoms of neuropathic pain in the upper limbs if the nerve is significantly involved in the neuropathic pain in the upper limbs. Nii and colleagues stated that the indications of ETS for neuropathic pain should be carefully considered because the efficacy decreases over time. An early sympathetic nerve block is recommended since the treatment outcome is better in patients treated early than in those treated later. However, the treatment of CRPS requires drugs, rehabilitation, and psychological follow-up because surgery alone will be insufficient.
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Peripheral Circulatory Disorders of the Upper Limbs - The peripheral circulatory disorders of the upper limbs are good indications for ETS to promote pain relief and ulcer healing such as Buerger’s disease, arteriosclerosis obliterans (ASO), and Raynaud’s disease.
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Angina - Angina is a condition in which the heart does not get sufficient oxygen and the patient suffers from increased pain in the heart from angina. ETS prevents this cycle by causing bradycardia (low heart rate) to reduce the heart strain and blocking the pain receptors to relieve pain. However, the efficacy often decreases with the progression of the underlying disorder.
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Chronic Abdominal Pain - ETS is performed on the mid to lower thoracic sympathetic nerve to reduce pain associated with chronic pancreatitis (inflammation of the pancreas). However, recurrence at about six months is likely due to the progression of the symptoms or involvement of other pain circuits.
How Is Endoscopic Thoracic Sympathectomy Performed?
ETS is typically performed on patients who have not responded to other treatments for hyperhidrosis or blushing, such as antiperspirants or medications. The procedure is generally safe and effective, but it can have potential complications. The physician creates tiny incisions in the skin throughout the process to the chest wall and inserts a thin tube called an endoscope. The endoscope contains a tiny camera and surgical instruments, which the surgeon uses to locate and cut or remove the targeted sympathetic nerves. The procedure is performed under general anesthesia.
What Are the Complications of Endoscopic Thoracic Sympathectomy?
Complications of ETS may occur during or after the procedure. Postoperative (after-surgery) complications are especially troublesome. The following are the complications of ETS:
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Compensatory Sweating - Sweating in the abdomen, back, buttocks, or lower limbs may be increased. The consent of the patient before surgery is necessary.
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Gustatory Sweating - Gustatory sweating refers to the condition in which the patients may start sweating in the face as soon as they start eating. Gustatory sweating may increase after ETS.
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Unexplainable Fever - Patients may complain of other symptoms such as fever. The exact cause of the fever is not known.
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Intolerance to Coldness or Hotness - The patients suffer from unidentified symptoms such as they are intolerant to temperatures either cold or hot after ETS.
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Absence of Smell and Taste - The patients felt the disappearance of the senses of smell and taste after ETS.
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Eczema - The condition in which patients suffer from skin irritation and itching is known as eczema.
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Malaise - Malaise refers to the general feeling of illness or discomfort. Some patients may complain about general malaise after ETS.
Conclusion
The ETS procedure, as well as the complications and indications, are detailed in the article. Despite the effectiveness of the treatment, compensatory sweating is always expected, thus patients must be well aware of it and grant their agreement. ETS will be an effective treatment if the doctor takes the time to carefully and thoroughly explain to the patient what to expect. ETS helps enhance the patient's standard of living.
