الفهرس 
HISTORY OF SYMPATHETIC SURGERYOnly 14 pages are availabe for public view
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Abstract
Looking into the thoracic cavity (thoracoscopy) is an old method already described in 1922 by the Swedish physician Jacobaeus.
Thoracoscopy was originally developed to diagnose and manage patients with pleural disease. Nonetheless, the technique subsequently achieved only limited application.
With the rapid improvement of endoscopic instruments, light sources and light weight cameras the role of thoracoscope in performing complex intrathoracic procedures expanded.
Upper dorsal symapthectomy has been performed through the conventional open approaches for more than seven decades. It was commonly performed for management of disorders as diverse as essential hypertension, bronchial asthma, angina pectoris, hyperthyroidism, and even the crisis of tertiary syphilis.
Today the application of sympathectomy in the practice is limited to the treatment of several socially and economically disabling conditions associated with excessive sympathetic vasomotor or pilomotor disorders or autonomic mediated pain syndromes.
Minimally invasive excision or ablation of the dorsal sympathetic chain has been performed since 1943 with thoracoscopic resection of the sympathetic chain. Since 1990s dorsal sympathectomy through conventional open approaches is being gradually replaced by thoracoscopic approach.
Thoracoscopic sympathectomy is preferred to open surgical procedures for dorsal sympathectomy. Being minimally invasive, fast, safe with minimal morbidity, less economic costs, shorter hospital stay and better cosmetic results.
The aim of this study was to assess and compare extended thoracoscopic sympathectomy in which ablasion of T2-T3 ganglia is done and limited thoracoscopic sympathectomy in which only T2 ganglia is ablated as regard operative time, intra operative difficulties, intraoperative, postoperative complications, and patients satisfaction (efficacy) postoperatively.
We performed 44 sympathectomies, 20 extended thoracoscopic sympathectomy and 24 limited thoracoscopic sympathectomy. We found that limited sympahtectomy is as equally effective as extended sympathectomy as regard post operative patients satisfaction. However limited thoracoscopic sympathectomy took less mean operative time, evoked less dryness of hands postoperative and less compensatory hyperhidrosis. Other complications were comparable, nearly equal post operative pain, and post operative stay time.
As a conclusion, limited thoracoscopic sympathectomy is a simple, safe operation with nearly equal efficacy to extended sympathectomy and less complication specially compensatory hyperhidrosis.