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Abstract
Sympathectomy has been long used for a variety of indications. Nowadays, sympathectomy retains a role in treatment of patients with hyperhydrosis, causalgia, sympathetic vasospasm, and peripheral arterial occlusive disease not amenable for direct reconstructable surgery.
Chemical and radiofrequency sympathectomy have been introduced as a less invasive means of achieving sympatholysis.
With the rapid improvement of endoscopic instruments, light sources and light weight cameras, the role of thoracoscope and laparoscope in performing complex procedures expanded. In addition to that, the incorporation of video-technology into conventional methods added more to the capability of endoscopy as it adds both magnification and better illumination.
With the revolution of endoscopic surgery, the techniques of endoscopic thoracic and lumbar sympathectomy have been raised, tested and evaluation.
In this thesis, the surgical aspects for each method of sympathectomy (percutaneously and endoscopically) have been tackled and these include:
- Preoperative preparation and anesthesia.
- Positioning on the operating table.
- Incision and instruments.
- Intraoperative procedures.
- Post operative care.
The patient undergoing endoscopic operation should be examined medically as regard the fitness for anesthesia with special stress on the history of previous lung or pleural diseases and history of previous abdominal surgery that may contradict absolutely or relatively the procedure. As one lung anesthesia will be attended. Pre-operative chest X-ray should be done to exclude underlying lung pathology as well as abdominal and pelvic studies.
Anesthetic personal should be experienced in one lung anesthesia and open procedures as well as the operating team, if conversion to open surgery is necessary. The patient should be subjected intraoperative to continuous monitoring of vital signs and arterial blood gases.
Endoscopic or percutaneous sympathectomy is preferred over the open surgical procedure as it is described to be minimally invasive, best cosmetic results, fast and safe procedure with minimal morbidity, shorter hospital stay, and less economic cost
Complications of endoscopic or percutaneous sympathectomy are few, and can be either general as regard any surgery or specifically to the procedure.
endoscopic and percutaneous sympathectomy replace now their counterpart open surgical procedure.