Evaluation and Testing

Department of Cardiothoracic Surgery
Peer Review Status: Internally Peer Reviewed

A thorough medical history is required of all patients undergoing thoracoscopic sympathectomy. Patients must completely abstain from smoking for a minimum of two weeks prior to their surgery. Depending upon age, all that is required is a chest x-ray preoperatively. If the patient is over the age of 45 we also obtain an electrocardiogram. This will require a clinic visit preoperatively to discuss the procedure, take an adequate history and physical, and obtain the necessary laboratory evaluations. You will then be admitted the morning of the procedure and discharged that same day. You will be given a return clinic visit appointment with us for approximately two weeks later for your postoperative evaluation. No follow-up care should be required after this.

Expected Hospital Course
Since 1997, we have been performing bilateral thoracoscopic sympathectomy as outpatient procedures. The operating time is approximately 1-1 l/2 hours with additional three hour stay in the recovery room followed by a chest x-ray and discharge the same day.

Results of Treatment
Since the results are immediate in most patients, patients will notice a difference when they awaken in the recovery room. Because of narcotics, which are used during the operative procedure, it is difficult to determine whether a Horner's syndrome is present or not since narcotics cause papillary constriction. The best long-term results for hyperhidrosis are associated with removal of the chain from T2-T4.

Prognosis
Our experience has been excellent. We have had no patients return with hyperhidrosis. We have performed more than 200 procedures.

Complications
Complications include but are not limited to:

• Horner's Syndrome: This is from cross innervation from the T2 to the T1 nerve root which results in a cosmetic deformity on that side of the hemithorax which results in decreased facial sweating, an eyelid which falls to the level of the pupil instead of the iris and a small pupil on the side.
• Compensatory Hyperhidrosis: this refers to sweating occurring in other sites from the nipple line down that may not have been apparent before. This may occur in up to 30% of patients for up to three months. It is usually self-limited. There is a small risk of this becoming a permanent complication in approximately 3% of patients. At the present time, there is no absolute treatment for this complication. When this occurs, it usually occurs on the anterior or posterior thigh or the small of the back.
• Pneumothorax: A pneumothorax is a collapsed lung from an injury over the covering of the lung called the pleura. This usually requires observation and sometimes may require a chest tube until the leak subsides with conservative therapy.
• Bleeding: is extremely rare. Should this occur, a possible thoracotomy may be required to control this problem.
• Infection: is also extremely rare. However, wound site infections can occur as well as infections within the chest.
• Pain: can occur with any thoracoscopic technique. This is usually transient. Two percent of patients can have long-term pain syndromes associated with any thoracic intervention &endash; whether this is done via thoracoscopy or thoracotomy.
• The risk of stroke and death are also possible, but extremely rare.