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Vol. 47. Issue 2.
Pages 94-102 (January 2011)
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Vol. 47. Issue 2.
Pages 94-102 (January 2011)
SEPAR Guidelines
DOI: 10.1016/S1579-2129(11)70020-9
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Guidelines on Surgery of the Thoracic Sympathetic Nervous System
Normativa sobre Cirugía del Sistema Nervioso Simpático Torácico
Visits
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Ramón Moreno Balsalobrea,??
Corresponding author
rmoreno@separ.es

Corresponding author.
, Nicolás Moreno Matab, Ricard Ramos Izquierdoc, Francisco Javier Aragón Valverded, Laureano Molins López-Rodoe, Juan José Rivas De Andrésf, José Luis García Fernándezg, Miguel Ángel Cañizares Carreteroh, Miguel Congregado Loscertalesi, Miguel Carbajo Carbajoj
a Servicio de Cirugía Torácica, Hospital Universitario de La Princesa, Madrid, Spain
b Servicio de Cirugía Torácica, Hospital Universitario Gregorio Marañón, Madrid, Spain
c Servicio de Cirugía Torácica, Hospital de Bellvitge, Barcelona, Spain
d Servicio de Cirugía Torácica, Hospital Central de Asturias, Oviedo, Asturias, Spain
e Servicio de Cirugía Torácica, Hospital Sagrado Corazón, Barcelona, Spain
f Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, Spain
g Servicio de Cirugía Torácica, Hospital Infanta Cristina, Badajoz, Spain
h Servicio de Cirugía Torácica, Hospital Universitario Xeral Cies, Vigo, Pontevedra, Spain
i Servicio de Cirugía Torácica, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
j Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
Article information
Abstract

Thoracic sympathetic nervous system (SNS) surgery has increased in importance in recent years, generating great expectations among the general population and the scientific community. This has been due to the excellent results obtained by video-assisted thoracic sympathectomy in the treatment of essential hyperhidrosis and other thoracic SNS disorders.

This minimally invasive surgical technique has been shown to be effective and to have low morbidity. It is accepted as one of the best therapeutic options for the treatment of palmar and bilateral axillary hyperhidrosis, and the number of patients interested in undergoing the procedure has increased considerably.

Although compensatory sweating, which is occasionally intense, often occurs after the surgery, this and other side effects of the technique are well tolerated by patients.

The current evidence on thoracic SNS and the treatment of essential hyperhidrosis is based on observational studies, making it difficult to compare series and draw conclusions. There has been much discussion on standardizing the technique, defining the most favorable levels for clipping, and choosing the type of denervation with the least amount of side effects. This has led to the need to draw up these guidelines which should clarify and standardize the criteria for managing patients with thoracic SNS disorders.

Keywords:
Thoracic sympathectomy
Hyperhidrosis
Facial flushing
Video-assisted thoracoscopy
Side effects
Compensatory sweating
Clipping
Guidelines
Thoracic surgery
Resumen

La cirugía del sistema nervioso simpático torácico (SNST) ha experimentado un gran auge en los últimos años, generando gran expectación entre la población general y la comunidad científica. Esto se ha debido a los excelentes resultados que ha obtenido la simpatectomía torácica por videotoracoscopia en el tratamiento de la hiperhidrosis esencial y en otros trastornos del SNST.

Esta técnica de cirugía mínimamente invasiva ha demostrado ser efectiva y con baja morbilidad, aceptada como una de las mejores opciones terapéuticas para el tratamiento de la hiperhidrosis palmar y axilar bilateral, viéndose incrementado de manera considerable el número de pacientes que consultan con intención de operarse.

Aunque la sudoración compensadora, intensa en ocasiones, aparece con gran frecuencia tras la cirugía, éste y otros efectos secundarios de la técnica son bien tolerados por los pacientes.

La evidencia actual respecto a la cirugía del SNST y del tratamiento de la hiperhidrosis esencial se basa en estudios observacionales, haciendo difícil comparar series y extraer Conclusiones Se ha discutido mucho para unificar la técnica, definir los niveles de sección más favorables y elegir el tipo de denervación con menos efectos secundarios. Este hecho crea la necesidad de elaborar esta normativa que clarifique y unifique criterios para el manejo de los pacientes con trastornos del SNST.

Palabras clave:
Simpatectomía torácica
Hiperhidrosis
Rubor facial
Videotoracoscopia
Efectos secundarios
Sudoración compensadora
Clipping
Normativa
Cirugía torácica
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References
[1.]
H.J. Schunemann, R. Jaeschke, D.J. Cook, W.F. Bria, A.A. El-Solh, A. Ernst, et al.
An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations.
Am J Respir Crit Care Med, 174 (2006), pp. 605-614
[2.]
C.F. List, M.M. Peet.
Sweat secretion in man. II Anatomic distribution of disturbances in sweating associated with lesions of the sympathetic nervous system.
Arch Neurol Psychiatry, 40 (1938), pp. 27-43
[3.]
I.H. Chung, C.S. Oh, K.S. Koh.
Anatomic variations of the T2 nerve root (including the nerve of Kuntz) and their implications for sympathectomy.
J Thorac Cardiovasc Surg, 123 (2002), pp. 498-501
[4.]
L. Ramsaroop, B. Singh, J. Moodley.
Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era.
Cin Anat, 17 (2004), pp. 294-299
[5.]
R. Moreno Balsalobre, Y.W. Pun Tam, V. Prieto Vicente, L. Fernández Fau.
Nuevas perspectivas para la hiperhidrosis palmar y axilar: simpatectomía torácica por videotoracoscopía.
Rev Patol Respir, 3 (2000), pp. 71-74
[6.]
K.M. Ro, R.M. Cantor, K.L. Lange, S.S. Ahn.
Palmar hyperhidrosis: evidence of genetic transmission.
J Vasc Surg, 35 (2002), pp. 382-386
[7.]
A. Haider, N. Solish.
Focal hyperhidrosis: diagnosis and management.
CMAJ, 172 (2005), pp. 69-75
[8.]
J. Hornberger, K. Grimes, M. Naumann, D.A. Glaser, N.J. Lowe, H. Naver, Multi-Specialty Working Group on the Recognition, et al.
Diagnosis and Treatment of primary focal hyperhidrosis.
J Am Acad Dermatol, 51 (2004), pp. 274-286
[9.]
R. Ramos, J. Moya, V. Turón, J. Pérez, R. Villalonga, R. Morera, et al.
Hiperhidrosis primaria y ansiedad: estudio prospectivo preoperatorio de 158 pacientes.
Ach Bronconeumol, 41 (2005), pp. 88-92
[10.]
A.L. Krogstad, A. Skymne, G. Pegenius, M. Elam, G. Wallin.
Evaluation of objective methods to diagnose palmar hyperhidrosis and monitor effects of botulinum toxin treatment.
Clin Neurophysiol, 115 (2004), pp. 1909-1916
[11.]
J.M. Swinehart.
Treatment of axillary hyperhidrosis: combination of the starchiodine test with the tumescent liposuction technique.
Dermatol Surg, 26 (2000), pp. 392-396
[12.]
R.A. Edmonson, A.K. Banerjee, J.A. Rennie.
Endoscopic transthoracic sympathectomy in the treatment of hyperhidrosis.
Ann Surg, 215 (1992), pp. 289-293
[13.]
E. Holzle, O. Braun-Falco.
Structural changes in axillary eccrine glands following long-term treatment with aluminium chloride hexahydrate solution.
Br J Dermatol, 110 (1984), pp. 399-403
[14.]
Hiperhidrosis: Diagnóstico y tratamientos actuales,
[15.]
J.C. Dahl, L. Glent-Madsen.
Treatment of hyperhidrosis manuum by tap water iontophoresis.
Acta Derm Venereol, 69 (1989), pp. 346-348
[16.]
J. Moya, R. Ramos, R. Morera, R. Villalonga, V. Perna, I. Macia, et al.
Resultados de la simpaticólisis y la simpatectomía torácica superiorbilateral endoscópica en el tratamiento de la hiperhidrosis primaria. Estudio de 1.016 procedimientos.
Arch Bronconeumol, 42 (2006), pp. 230-234
[17.]
N. Doolabh, S. Horswell, M. Williams, L. Huber, S. Prince, D.M. Meyer, et al.
Thoracoscopic sympathectomy for hyperhidrosis: indications and results.
Ann Thorac Surg, 77 (2004), pp. 410-414
[18.]
Y. Matsumoto, T. Ueyama, M. Endo, H. Sasaki, F. Kasashima, Y. Abe, et al.
Endoscopic thoracic sympathicotomy for Raynaud's phenomenon.
J Vasc Surg, 36 (2002), pp. 57-61
[19.]
J. Moodley, B. Singh, A. Snaik, A. Haffejee, J. Rubin.
Thoracoscopic splanchnicectomy: pilot evaluation of a simple alternative for chronic pancreatic pain control.
World J Surg, 23 (1999), pp. 688-892
[20.]
T. Howard, J. Swofford, D. Wagner, S. Sherman, G. Lehman.
Quality of life alter bilateral thoracoscopic splanchnicectomy: long-term evaluation in patients with chronic pancreatitis.
J Gastrointest Surgery, 6 (2002), pp. 845-854
[21.]
F.J. Baumgartner.
Surgical approaches and techniques in the management of severe hyperhidrosis.
Thorac Surg Clin, 18 (2008), pp. 167-181
[22.]
Y.J. Hsieh, C.M. Chen, H.Y. Lin, T.F. Young.
Experience of anesthesia during transthoracic endoscopic sympathectomy for palmar hyperhidrosis: comparison between double-lumen endobronchial tube ventilation and laryngeal mask ventilation.
Acta Anaesthesiol Sin, 32 (1994), pp. 13-20
[23.]
C.C. Lin, T. Telaranta.
Lin-Telaranta classification: the importance of different procedures for different indications in sympathetic surgery.
Ann Chir Gynaecol, 90 (2001), pp. 161-166
[24.]
S.H. Chou, E.L. Kao, C.C. Lin, Y.T. Chang, M.F. Huang.
The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464 cases.
Surg Endosc, 20 (2006), pp. 1749-1753
[25.]
C. Neumayer, J. Zacherl, G. Holak, R. Fugger, R. Jakesz, F. Herbst, et al.
Limited endoscopic thoracic sympathetic block for hyperhidrosis of the upper limb: reduction of compensatory sweating by clipping T4.
Surg Endosc, 18 (2004), pp. 152-156
[26.]
R. Menezes, J. Ribas, D. Wen, M. Paiula, M. Bessa, M. Gesteira, et al.
Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis.
J Bras Pneumol, 24 (2008), pp. 967-977
[27.]
J. Fibla, L. Molins, J. Mier, G. Vidal.
Effectiveness of sympathetic block by clipping in the treatment of hyperhidrosis and uncontrollable facial blushing.
Interac Cardiovasc Thorac Surg, (2009), pp. 212-365
[28.]
D.H. Yoon, Y. Ha, Y.G. Park, J.W. Chang.
Thoracoscopic limited T-3 sympathicotomy for primary hyperhidrosis: prevention for compensatory hyperhidrosis.
J Neurosurg, 99 (2003), pp. 39-43
[29.]
J. Loscertales, A. Arroyo Tristán, M. Congregado Loscertantes, R. Jiménez Merchan, J. Girón Arjona, C. Arenas Linares.
Tratamiento de la hiperhidrosis palmar por simpatectomía torácica. Resultados inmediatos y calidad de vida postoperatoria.
Arch Bronconeumol, 40 (2004), pp. 67-71
[30.]
B. Weksler, J.D. Luketich, M.R. Shende.
Endoscopic thoracic sympathectomy: at what level should you perform surgery?.
Thorac Surg Clin, 18 (2008), pp. 183-191
[31.]
Y. Liu, J. Yang, J. Liu, F. Yang, G. Jiang, J. Li, et al.
Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy.
Eur J Cardiothorac Surg, 35 (2009), pp. 398-402
[32.]
A. Kunt.
Distribution of the sympathetic rami to the brachial plexus. Its relation to sympathectomy affecting the upper extremity.
Arch Surg, 15 (1927), pp. 871-877
[33.]
H. Kim do, Y.J. Hong, J.J. Hwang, K.D. Kim, D.Y. Lee.
Topographical considerations under video-scope guidance in the T3,4 levels sympathetic surgery.
Eur J Cardiothorac Surg, 33 (2008), pp. 786-789
[34.]
B. Singh, J. Moodley, P.K. Ramdial, L. Ramsaroop, K.S. Satyapal.
Pitfalls in thoracoscopic sympathectomy: mechanisms for failure.
Surg Laparosc Endosc Percutan Tech, 11 (2001), pp. 364-367
[35.]
M.A. Callejas, M. Rubio, M. Iglesias, J. Belda, E. Canalis, M. Catalán, et al.
Simpatectomía torácica por videotoracoscopia para el tratamiento del ruborfacial: bisturí ultrasónico frente a diatermia.
Arch Bronconeumol, 40 (2004), pp. 17-19
[36.]
L. Molins, J.J. Fibla, J.M. Mier, A. Sierra.
Outpatient thoracic surgery.
Thorac Surg Clin, 18 (2008), pp. 321-327
[37.]
R. Moreno Balsalobre, Y.W. Pun Tam, J.L. García Fernández, R. Risco Rojas, S. Amor Alonso, R. Roses Roses, et al.
Simpatectomía Torácica por Cirugía Mayor Ambulatoria (CMA). ¿Se pierde calidad asistencial?.
Arch Bronconeumol, 44 (2008), pp. 104S
[38.]
X. Li, Y.R. Tu, M. Lin, F.C. Lai, J.F. Chen, H.W. Miao.
Minimizing endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: guided by palmar skin temperature and laser doppler blood flow.
Ann Thorac Surg, 87 (2009), pp. 427-431
[39.]
P.M. Rodríguez, J.L. Freixinet, M. Hussein, J.M. Valencia, R.M. Gil, J. Herrero, et al.
Side effects, complications and outcome of thoracoscopic sympathectomy for palmar and axillary hyperhidrosis in 406 patients.
Eur J Cardiothorac Surg, 34 (2008), pp. 514-519
[40.]
L. Molins, C. Simon, J. Buitrago, G. Vidal.
Tratamiento quirúrgico de la hiperhidrosis palmar y axilar.
Arch Bronconeumol, 39 (2003), pp. S50-S56
[41.]
P. Dumont.
Side effects and complications of surgery for hyperhidrosis.
Thoracic Surg, 18 (2008), pp. 193-207
[42.]
M. Congregado.
Impacto de la simpatectomía dorsal videotoracoscópica en la cirugía torácica. Implicaciones futuras.
Arch Bronconeumol, 46 (2009), pp. 1-2
[43.]
T. Teleranta.
Secondary sympathetic chain reconstruction after endoscopic thoracic sympathicotomy.
Eur J Surg, 164 (1998), pp. S17-S18
[44.]
M.J. Latif, J.N. Afthinos, C.P. Connery, N. Perin, F.Y. Bhora, M. Chwajol, et al.
Robotic intercostal nerve graft for reversal of thoracic sympathectomy: a large animal feasibility model.
Int J Med Robot, 4 (2008), pp. 258-262
[45.]
C.C. Lin, L.R. Mo, L.S. Lee, S.M. Ng, M.H. Hwang.
Thoracoscopic T2-sympathetic block by clipping-a better and reversible operation for treatment of hyperhidrosis palmaris: experience with 326 cases.
Eur J Surg Suppl, (1998), pp. 13-16
[46.]
R. Reisfeld.
Sympathectomy reversal. Clamping vs Nerve graft. Eighth International Symposium on Sympathetic Surgery (ISSS).
USA, (2009),
[47.]
T.S. Lin, M.C. Chou.
Treatment of palmar hyperhidrosis using needlescopic T2 sympathetic block by clipping: analysis of 102 cases.
Int Surg, 89 (2004), pp. 198-201
[48.]
R. Reisfeld.
Sympathectomy for hyperhidrosis: should we place the clamps at T2-T3 or T3-T4?.
Clin Auton Res, 16 (2006), pp. 384-389
[49.]
K.H. Jo, S.W. Moon, Y.D. Kim, S.B. Sim, D.G. Cho, U. Jin, et al.
New protocol for a reversal operation in endoscopic thoracic sympathetic clamping: pulling back the suture sling linked to the clip under local anesthesia.
Surg Laparosc Endosc Percutan Tech, 17 (2007), pp. 29-32
[50.]
C.W. Kang, S.Y. Choi, S.W. Moon, D.G. Cho, J.B. Kwon, S.B. Sim, et al.
Short-term and intermediate-term results after unclipping: what happened to primary hyperhidrosis and truncal reflex sweating after unclipping in patients who underwent endoscopic thoracic sympathetic clamping?.
Surg Laparosc Endosc Percutan Tech, 18 (2008), pp. 469-473
[51.]
R. Reisfeld, R. Nguyen, A. Pnini.
Endoscopic thoracic sympathectomy for hyperhidrosis: experience with both cauterization and clamping methods.
Surg Laparosc Endosc Percutan Tech, 12 (2002), pp. 255-267
[52.]
P.B. Licht, H.K. Pilegaard.
Management of facial blushing.
Thorac Surg Clin, 18 (2008), pp. 223-228
[53.]
A. Malmimaara, P. Kuukasjarvi, I. Autti-Ramo.
Effectiveness and safety of endoscopic thoracic sympathectomy for excessive sweating and facial blushing: a systematic review.
Int J Technol Assess Health Care, 23 (2007), pp. 54-62
[54.]
K. Komori, K. Kawasaki, J. Okazaki, D. Eguchi, K. Mawatari, K. Okadome, et al.
Thoracoscopic sympathectomy for Buerger's disease of the upper extremities.
J Vasc Surg, 22 (1995), pp. 344-346
[55.]
T. DeGiacomo, E. Rendina, F. Venuta, D. Lauri, E. Mercadante, M. Anile.
Thoracoscopic sympathectomy for symptomatic arterial obstruction of the upper extremities.
Ann Thorac Surg, 74 (2002), pp. 885-888
[56.]
P. Kumar, F. Moussa, N. Nesher, B. Goldman.
History of surgical treatment of ischemic heart disease -pre’coronary by-pass grafting’- era.
J Card Surg, 22 (2007), pp. 242-246
[57.]
M. Fechir, C. Geber, F. Birklein.
Evolving understanding about Complex Regional Pain Syndrome and its treatment.
Curr Pain Headache Rep, 12 (2006), pp. 186-191
[58.]
P. Mallet-Guy.
La splanchnicectomie gauche dans le traitement des pancreatitis chroniques.
Presse Med, 51 (1943), pp. 145-146
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