| Abstract: |
ABSTRACTBackground: As early as in 1889 surgery on the cervical sympathetic nervous system was performed. During the following decades this operation was tried for a variety of diseases. In the early 1920s it was clarified that patients with hyperhidrosis, vasospastic conditions, and angina pectoris would benefit from stellectomy. It was, however, soon discovered that removal of the upper thoracic ganglia was required in order to obtain complete sympathetic denervation of the upper extremity. Several open surgical techniques for upper thoracic sympathectomy were described. During the 1940s a few pioneers started to excise sympathetic ganglia by thoracoscopy which had originally been described as a diagnostic tool by Jacobaeus in 1910. Endoscopic approach, documented by Kux in 1954, did not gain widespread popularity until 1980s. Like the general upsurge of interest in endoscopic surgery, thoracoscopic ablation of the upper thoracic sympathetic ganglia is now rapidly being adopted by surgeons. The autonomic nervous system runs to almost every organ, in the body, these nerves play a role in how the body is able to automatically adjust levels on many different body functions in response to changes in the environment, exercise and emotion. Scientists wondered what might change if various parts of it were removed. Sympathectomy refers to the destruction of tissue anywhere in either of the two sympathetic trunks (long chains of nerve ganglia lying along either side of the spine). Each trunk is broadly divided into three regions: cervical (up by the neck), thoracic (in the chest) and lumbar (in the lower back). The most common targeted area in sympathectomy is the upper thoracic region, the part of the sympathetic chain lying between the first and fifth thoracic vertebrae. A great variety of techniques have been described for sympathetic denervation. As none invasive approaches (Medical treatment), minimally invasive approaches (Endoscopic sympathectomy and Percutaneous Sympathicolysis), and invasive approaches (open surgical sympathectomy). Thoracoscopic sympathectomy is a minimally invasive procedure. An excellent view of the upper dorsal sympathetic chain can usually be obtained and simple diathermy coagulation of the chain can be achieved. These minimally invasive techniques also have evolved, from complex staged procedures with multiple ports to more simplified biportal and uniportal procedures that require minimal tissue disruption and more limited yet effective sympathectomy procedures. Minimally invasive endoscopic-assisted posterior thoracic sympathectomy may provide an alternative to thoracoscopic approaches, especially in those patients with severe pulmonary disease in which the thoracic cavity is obliterated or morbid obesity. Thoracoscopic sympathectomy is used to treat hyperhidrosis, facial blushing, Reynaud’s disease, Reflex Sympathetic Dystrophy, and angina pectoris. By far the most common complaint treated with thoracoscopy is palmer hyperhidrosis , or ”sweaty palms”. Hyperhydrosis is sweating that exceeds the need for normal thermoregulation of the skin. Primary hyperhidrosis usually starts in childhood & is of unknown aetiology. Secondary hyperhydrosis may be due to various endocrine conditions e.g. hyperthyroidism, pheochromocytoma, diabetes mellitus, acromegaly and hyperpituitarism. Severely symptomatic arterial insufficiency of the hand and upper extremities requires adequate treatment. Medical therapy and local care are usually unsuccessful, thorathic sympathectomy can represent an effective procedure to control pain, to help ulcer healing, and to prevent or delay amputation.Objectives: The aim of this work is to review and evaluate the benefits and updated techniques for Thoracoscopic Sympathectomy.
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