|
1. What is Endoscopic Thoracic Sympathectomy?
The nerves that supply the sweat glands in the armpit and palms can be cut to reduce the amount of sweating. These nerves lie deep in the neck, close to the spine and the traditional operations to divide them, using a neck or armpit incision, left a sizeable scar and were often accompanied by complications. The operation was therefore only done in very severe cases. However, thanks to the development of "keyhole" surgery the nerves can now be destroyed through 1 or 2 tiny holes in the chest using special instruments. This procedure is called a thoracoscopic sympathectomy or Endoscopic Thoracic Sympathectomy (ETS).
This operation is also being used to treat patients with severe facial blushing.
2. How is an Endoscopic Thoracic Sympathectomy carried out?
You will have a general anaesthetic for the operation. When you are asleep, a small hole is made in the upper chest. The lung, on the side being operated upon, is allowed to collapse a little to make some working room. Meanwhile your other lung is capable of doing all the work. A camera on a thin telescope is then put into the chest to find the nerves which are to be divided. Another small hole is made to put in the instruments that divide the nerves. The lung is then re-expanded and the instruments removed. Sometimes a small drain (plastic tube) is left in the chest for a few hours to make sure all the air is removed from the chest cavity. Usually, it is possible to do both left and right sides at the same operation if required but sometimes only one side is done at a time.
3. How long do I have to be in hospital?
Although it is possible to have this operation as a day case, in most cases you will be kept in overnight after the operation. Occasionally, if the lung takes a bit of time to expand, you may have to stay in slightly longer. Rarely, a small drain (plastic tube) is needed to help the lung expand. This is more likely if you have both sides done at one operation.
4. How successful is thoracoscopic sympathectomy?
This operation produces a highly satisfactory reduction in hand sweating in over 95% of patients and in the majority of cases the results are permanent. The operation is usually more successful for sweating of the palms, than the armpits. Sometimes the palms are so dry after the operation that moisturising cream is needed to prevent cracking of the skin. Stopping the palms and armpits sweating often results in extra sweating elsewhere. This "compensatory" sweating commonly occurs on the back below the shoulder blades, also on the legs and feet. Rarely, this is more of a nuisance than the original problem. Sometimes, sweating on the side of the face when eating can occur after the operation. For facial blushing the operation is successful in about 70% cases.
5. Are there any special complications of thoracoscopic sympathectomy?
There is a possibility of collapsed lung afterwards (pneumothorax). This can occur in around 1 in 30 patients. A chest x-ray is performed after the operation to exclude this and if necessary a plastic tube (chest drain) may need to be inserted into the chest. Drooping of the eyelid (Horner's Syndrome) on the side of the operation due to damage of the nerves in the root of the neck can occur but is rare (less than 1 in 50) and usually recovers spontaneously. Compensatory sweating elsewhere in the body frequently occurs (at least half the patients undergoing ETS) but is rarely more trouble than the original problem and usually affects a less embarrassing area e.g. the back or legs. Occasionally, sweating on the side of the face when eating can occur after the operation (gustatory sweating). The operation does have a small failure rate and the symptoms may recur in a small proportion of patients, months or even years after surgery. There is a very small risk of damage to major blood vessels or nerves within the chest which could necessitate open surgery on the chest (thoracotomy). Also, there is an extremely small risk of death with this operation, as with most other operations.
Sometimes the ribs where the telescope was inserted into the chest are sore for a few weeks and hurt on breathing in deeply or coughing. This is due to bruising of the ribs and gradually improves. Most patients return to work within a couple of weeks but sometimes more recovery time is needed, particularly if there is persistent discomfort within the chest wall or around the shoulder blades, as sometimes occurs.
|
|
