Endoscopic thoracic sympathectomy
Under the endoscopic transthoracic sympathectomy (ETS) is defined as the operative transection of individual ganglia of the sympathetic nervous system for the treatment of excessive sweating ( hyperhidrosis ) or of certain peripheral circulatory disorders.
Indication
The ETS is now regarded as promising treatment for hyperhidrosis as the armpits, hands or face. However, there are also critical voices, especially in view of the possible complications that recommend this surgical solution only as a last way. The Leitungswasseriontophorese to be as successful; but requires lifelong regular treatments.
Technology
For the operation of a general anesthesia is required.
The surgery is minimally invasive with special endoscopic instruments through one or more small incisions in the armpit and take on both sides of the body is usually no longer than 30 minutes. In the chest cavity, one or more of the skyscrapers along the vertebral nerve ganglia that stimulate the sweat glands, cut with different techniques or interrupted. The interruption with braces is usually recommended as the operation as reversible, so again remains reversible. This is useful if the ever-present compensatory sweating is even more detrimental effect than the actual sweating before.
The patient can leave the hospital after an ETS usually after a few days.
The ETS is paid in Germany by the statutory health insurance ( contact of the patient with the insurance company before a scheduled surgery for any clarification on the assumption of costs is required). A referral from a specialist (usually a dermatologist ) for outpatient presentation is sufficient.
Complications
- Horner's syndrome after erroneous violation of the uppermost ganglion leading to unilateral facial asymmetry with hanging eyelid.
- After a VATS (Video Assisted Thoracic Surgery ) temporary placement of a chest tube is usually required to fully develop the lungs again. In exceptional cases, be waived.
- Recurrent nerve palsy ( vocal cord paralysis due to damage to the Recurrensnerven for vocal cord with hoarseness ), pleural effusion.
Possible consequences
It always comes to the so-called compensatory sweating. The compensatory sweating says the secretion of body perspiration in other body regions. It always occurs because the ETS only redirect the Hyperhydrosissymptome, but can not finish. Often, the compensatory sweating occurs after an ETS over a large area on the back, abdomen, buttocks, thighs or feet.