New Protocol for a Reversal Operation in Endoscopic Thoracic Sympathetic Clamping: Pulling Back the Suture Sling Linked to the Clip Under Local Anesthesia

Abstract

Endoscopic thoracic sympathetic clamping (ETC) has widely been used for treating the patients with primary hyperhidrosis, as it offers the potential of reversal operation (unclipping) under general anesthesia (GA) when severe reflex sweating would occur. However, we modified ETC to unclip under local anesthesia. From March 2002 to January 2005, we performed ETC in 87 patients with primary hyperhidrosis. From September 2002 on, the suture sling which was made with a 3-0 propylphylene suture was additionally placed between the endoclip and the subcutaneous tissue of the thoracoport. When unclipping was needed, the endoclip was removed by being pulled back under portable fluoroscopy. Four of 53 patients (7.5%) who underwent ETC alone underwent unclipping under GA. By contrast, unclipping was successfully performed under local anesthesia in 5 of 34 patients (14.7%) who underwent the modified ETC. ETC will be more effective operation if it is modified concomitantly with the suture sling; otherwise the reversal operation will need GA for the unclipping.

Long-term outcomes associated to video-assisted thoracic sympathotomy for palmar-axillar subtype of the hyperhidrosis

“…The simple section of the sympathetic chain, resection of ganglia, resection of the entire chain, ablation and thermocoagulation are considered as definitive techniques. Interruption of the chain using staples ("clipping ") is described as being potentially reversible 21 . Simple transection of the nervous pathway (denominated as simpathotomy) has been our technique of choice due to the ease for its application: surgery become faster and safer, reducing the blood loss, the lung manipulation, the time of lung deflating and the risk of damaging some of the vital intrathoracic structures (as the azygos vein).…”

The Effect of Thoracosopic Thoracic Sympathetomy on Pulmonary Function and Bronchial Hyperresponsiveness

“…The surgical procedure is described elsewhere (11,12). Briefly, the patients were placed under general anesthesia in a semi-sitting position with both arms abducted.…”

Short-term and Intermediate-term Results After Unclipping

“…14,17 Briefly, under general anesthesia and using single lumen tracheal intubation, the patient was placed in a semisitting position with both arms abducted. Two 7mm thoracoports were made to place a 30-degree thoracoscope and instruments.…”

“…13 The reversal operation or reconstructive surgery is performed to treat severe RS, other neurologic complications (ptosis), or symptomatic bradycardia. [1][2][3][4][5][14][15][16] Technical modifications of these procedures have developed according to the surgical techniques previously performed. 1,2,13 Unclipping after ETC for PH has been increasingly reported with good results.…”

“…This study prospectively analyzed 14 patients who underwent an unclipping procedure. 14 Of 116 patients, 15 patients underwent an unclipping procedure under general or local anesthesia. The medical charts, chest x-ray, and surgical video records were reviewed, and a telephone interview on the severity of RS, the recurrence of sweating in the primary site (face and palm), and their level of satisfaction was performed on 14 patients with a minimum follow-up period of 6 months.…”