Name of the Procedure:

Thoracoscopy, surgical; with thoracic sympathectomy
Common Name(s): Video-Assisted Thoracic Surgery (VATS) with Sympathectomy, Endoscopic Thoracic Sympathectomy (ETS)

Summary

Thoracoscopy with thoracic sympathectomy is a minimally invasive surgery where a small camera (thoracoscope) is inserted into the chest cavity to visualize and sever part of the sympathetic nerve chain. This procedure is typically performed to alleviate symptoms associated with disorders of the sympathetic nervous system.

Purpose

Medical Condition or Problem It Addresses

• Hyperhidrosis (excessive sweating)
• Facial blushing
• Severe Raynaud’s phenomenon
• Certain types of chronic pain (e.g., reflex sympathetic dystrophy)

Goals or Expected Outcomes

• Reduce or eliminate excessive sweating
• Alleviate symptoms of facial blushing
• Improve blood flow in Raynaud’s phenomenon
• Decrease chronic pain

Indications

Specific Symptoms or Conditions

• Severe hyperhidrosis affecting the hands, face, or armpits
• Frequent and socially debilitating facial blushing
• Severe Raynaud’s disease not responding to other treatments
• Chronic pain conditions related to the sympathetic nervous system

Patient Criteria or Factors

• Symptoms significantly impact daily life and other treatments have failed
• No contraindications such as severe pulmonary or cardiovascular conditions

Preparation

Pre-procedure Instructions

• Fasting (usually from midnight before the procedure)
• Medication adjustments as advised by the healthcare provider
• Smoking cessation

Diagnostic Tests or Assessments

• Routine blood tests
• Pulmonary function tests
• Chest X-ray or CT scan

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incisions: Small incisions (usually 1-2) are made in the chest wall.
3. Thoracoscope Insertion: A thoracoscope is inserted through one of the incisions to provide a video feed of the chest cavity.
4. Sympathectomy: Using specialized surgical instruments, the surgeon identifies and severs the sympathetic nerve chain.
5. Closure: The instruments are removed, and the incisions are closed with sutures or staples.

Tools, Equipment, or Technology Used

• Thoracoscope
• Endoscopic surgical instruments
• Electrocautery devices

Anesthesia or Sedation Details

• General anesthesia is used, ensuring the patient is unconscious and pain-free during the procedure.

Duration

The procedure typically takes 1-2 hours.

Setting

Usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Thoracic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

Common Risks

• Pain at incision sites
• Infection
• Pneumothorax (collapsed lung)

Rare Risks

• Compensatory sweating (increase in sweating in other body areas)
• Horner's syndrome (drooping eyelid, constricted pupil)
• Nerve injury

Possible Complications

• Air leak from the lung
• Persistent pain
• Changes in heart rate

Benefits

• Immediate reduction in sweating or blushing
• Improved quality of life
• Resolution of symptoms that significantly impact daily activities

Recovery

Post-procedure Care and Instructions

• Pain management with prescribed medications
• Wound care and monitoring for signs of infection
• Breathing exercises to improve lung function

Expected Recovery Time

• Initial recovery period of 1-2 weeks, with full recovery in 4-6 weeks

Restrictions or Follow-up Appointments

• Avoid heavy lifting and strenuous activities for a few weeks
• Follow-up visit with the surgeon to monitor recovery

Alternatives

Other Treatment Options

• Medications (anticholinergics, beta-blockers)
• Botulinum toxin injections
• Iontophoresis

Pros and Cons of Alternatives

• Medications may provide temporary relief but can have systemic side effects.
• Botulinum toxin injections require repeated treatments.
• Iontophoresis is less invasive but typically less effective for severe cases.

Patient Experience

During the Procedure

• The patient is under general anesthesia and will not feel anything.

After the Procedure

• Post-operative pain or discomfort managed with medication
• Some patients may feel tired or experience mild chest tightness
• Pain management and comfort measures will be provided to help with recovery.