Endoscopic thoracectomy sympathectomy ( ETS ) is a surgical procedure in which some of the sympathetic nerves in the thoracic area are destroyed. ETS is used to treat excessive sweating in certain parts of the body (focal hyperhidrosis), reddened face, Raynaud's disease and sympathetic reflex dystrophy. By far the most common complaint handled with ETS is sweaty palms (palmar hyperhidrosis). This intervention is controversial and illegal in some jurisdictions. As with any surgical procedure, it has risks; sympathetic block-endoscopy (ESB) endoscopic procedures and procedures affecting fewer nerves have a lower risk.
Physical sympathectomy destroys the relevant nerve anywhere in one of two sympathetic stems, which is a long chains of nerve ganglia located bilaterally along the vertebral column (localization requiring low-risk injury) responsible for various important aspects of the nervous system peripheral (PNS). ). Each nerve bar is widely divided into three areas: cervix (neck), chest (chest), and lumbar (lower back). The most common area targeted in sympathectomy is the upper thoracic region, part of the sympathetic chain located between the first and fifth thoracic vertebrae.
Video Endoscopic thoracic sympathectomy
Indication
The most common indications for thoracic sympathectomy are focal hyperhidrosis (which specifically affects the hands and armpits), Raynaud's phenomenon, and face flushing when accompanied by focal hyperhidrosis. It can also be used to treat bromhidrosis, although this usually responds to non-surgical treatments, and sometimes people with olfactory reference syndrome are present for surgeons who ask for sympathectomy.
There are ETS reports used to achieve cerebral revascularization for people with moyamoya disease, and to treat headaches, hyperactive bronchial tubes, long QT syndromes, social phobia, anxiety, and other conditions.
Maps Endoscopic thoracic sympathectomy
Surgical procedure
ETS involves surgery of the main sympathetic stem in the thoracic region of the sympathetic nervous system, interfering with irreversible neural messages that will usually travel to many different organs, glands and muscles. It is through the nerves that the brain is able to make adjustments to the body in response to changing conditions in the environment, fluctuating emotional states, exercise levels, and other factors to maintain the body in the ideal state (see homeostasis).
Because these nerves also regulate conditions such as redness or excessive sweating, whose procedures are designed to be eliminated, the normative function performed by this physiological mechanism will be disabled or significantly impaired by sympathectomy.
There are many contradictions among ETS surgeons about the best surgical methods, optimal locations for nerve dissection, and the nature and extent of major effects and side effects. When the endoscope is done as usual, the surgeon penetrates the chest cavity making some incisions about the diameter of the straw between the ribs. This allows the surgeon to insert a video camera (endoscope) in one hole and a surgical instrument in another hole. This operation is performed by dissecting the neural network from the main sympathetic chain.
Another technique, the clamping method, also referred to as the 'endoscopic sympathetic blockade' (ESB) uses titanium clamps around the neural network, and is developed as an alternative to older methods in a failed attempt to make reversible procedures. Technical reversal of clamping procedure should be done within a short time after clamping (estimated at most several days or weeks), and recovery, evidence shows, will not be complete.
Physical, mental and emotional effects
The sympathectomy works by paralyzing the part of the autonomic nervous system (and thereby interfering with its signals from the brain), through surgical intervention, in the hope of eliminating or reducing the prescribed problem. Many non-ETS doctors have found this practice questionable mainly because the goal is to destroy the anatomical functional nerve.
The precise results of ETS are unlikely to predict, due to considerable variation in anatomy in nerve function from one patient to the next, and also because of variations in surgical techniques. The autonomic nervous system is not exactly anatomically and its connections may be unpredictable when the nerve is deactivated. This problem is indicated by a large number of patients undergoing sympathectomy at the same level for hand sweating, but who then present the reduction or elimination of sweaty feet, unlike others who are not affected in this way. There is no reliable operation to sweat the legs except lumbar sympathectomy, at opposite ends of the sympathetic chain.
Thoracic sympathectomy changes many body functions, including sweating, vascular response, heart rate, stroke volume of the heart, thyroid, baroreflex, lung volume, pupil dilatation, skin temperature and other aspects of the autonomic nervous system, such as important battles or flight. response. This reduces the physiological response to strong emotions, such as fear and laughter, reduces the body's physical reactions to pain and pleasure, and inhibits skin-like chills.
A large study of psychiatric patients treated surgically showed significant reductions in fear, alertness, and arousal. Passion is essential to awareness, in regulating attention and processing information, memory and emotions.
ETS patients are being studied using an autonomous failure protocol led by David Goldstein, M.D. Ph.D., senior researcher at the National Institute of Neurosurgical and Stroke Disorders in the US. He has documented the loss of thermoregulation, cardiovascular, and loss of vasoconstriction. The return of the original symptoms due to nerve regeneration or sprouting nerves can occur in the first year postoperatively. Sprouted nerves, or abnormal nerve growth after damage or injury to the nerves can cause further damage. Growing the sympathetic nerves can form connections with the sensory nerves, and leads to pain conditions that are mediated by the SNS. Whenever the system is activated, it translates into pain. This sprouts and action can cause Frey's syndrome, which is recognized after the sympathectomy effect, as the sympathetic nerves that grow involve the salivary glands, causing excessive sweating regardless of ambient temperature through olfaction or stimulant stimulation.
Risk
ETS has normal operating risks, such as bleeding and infection, conversion to open chest surgery, and some specific risks, including permanent and unavoidable changes in nerve function. It has been reported that a number of patients - 9 since 2010, mostly young women, have died during this procedure due to intrathoracic bleeding and brain disorders. Bleeding during and after surgery may be significant in up to 5% of patients. Pneumothorax (collapsed lung) may occur (2% of patients). Compensatory hyperhidrosis (or reflex hyperhidrosis) often occurs in the long run. Severe compensatory sweating rates vary greatly between studies, ranging from as high as 92% of patients. Of patients who develop this side effect, about a quarter of one study says it is a major and crippling problem.
The severe consequence of thoracic sympathectomy is corposcindosis (split-body syndrome), in which the patient feels that he lives in two separate bodies, since sympathetic nerve function has been divided into two distinct regions, one is dead, and the other is hyperactive.
In addition, the following side effects have been reported by the patient: Chronic muscular pain, numbness and weakness of the limbs, Horner's syndrome, anhidrosis (inability to sweat), hyperthermia (compounded by anhidrosis and systemic thermoregulatory dysfunction), neuralgia, paresthesia, fatigue and amotivationality , difficulty breathing, substantially reduced physiological/chemical reactions to internal and environmental experiences (eg pleasure and perceptual pain/stimulation), somatosensory damage, physiological reactions deviating from stress and effort etc., Raynaud's disease (ironically a possible indication for surgery), hyperhidrosis reflexes, changes/blood pressure and irregular circulation, defective flight systems or flight responses, adrenaline loss, eczema and other skin conditions resulting from very dry skin; rhinitis, sweating alcohol (also known as Frey syndrome).
Other long-term adverse effects include:
- Ultrastructure changes in cerebral artery walls caused by long-term sympathetic denervation
- Sympathectomy removes the psychogalvanic reflex
- Cervical sympathectomy reduces the heterogeneity of oxygen saturation in small cerebrocortical veins
- sympathetic denervation is one of the causes of MÃÆ'¶nckeberg sclerosis
- T2-3 sympathectomy suppresses heart rate baroreflex control in patients with palmar hyperhidrosis. Baroreflex response to maintain cardiovascular stability is suppressed in patients receiving ETS.
- Commercial heat stroke.
- Morphofunctional changes in the following myocardial sympathectomy.
Another side effect is the inability to raise a sufficient heart rate during exercise with an event requiring a pacemaker after developing a reported bradycardia as a consequence of surgery.
The Finnish Office for the Health Care Technology Assessment concluded more than a decade ago in a 400-page systematic review that ETS is associated with an unusually high amount of short-term and long-term adverse effects.
"This method can provide permanent side effects which in some cases will first become evident only after some time.One side effects may increase sweat in various places in your body Why and how does this happen? still unknown. According to available studies about 25-75% of all patients can expect more or less serious sweat at different places on their body, such as the trunk and crotch areas, this is compensatory sweat ".
In 2003, ETS was banned in his birthplace, Sweden, due to inherent risks, and complaints by disabled patients. In 2004, Taiwanese health authorities prohibited procedures in people under 20 years old.
History
Sympathectomy developed in the mid-19th century, when it was known that the autonomic nervous system runs into almost every organ, gland, and muscular system in the body. It is thought that these nerves play a role in how the body regulates many different body functions in response to changes in the external environment, and in emotions.
The first sympathectomy was performed by Alexander in 1889. The thoracic sympathectomy has been indicated for hyperhidrosis (excessive sweating) since 1920, when Kotzareff suggests it would cause anhidrosis (total sweating disability) of the nipple line upward.
Lumbar sympathectomy is also developed and used to treat excessive sweating of the feet and other diseases, and usually leads to impotence and retrograde ejaculation in men. Lumbar sympathectomy is still offered as a treatment for plantar hyperhidrosis, or as a treatment for patients who have poor results (extreme 'sweaty compensation') after a thoracic sympathectosis for palmar hyperhidrosis or flushing; However, extensive sympathectomy is at risk of hypotension.
Endoscopic sympathectomy itself is relatively easy to do; However, accessing neural networks in the chest cavity by conventional surgical methods is difficult, painful, and gave birth to several different approaches in the past. The posterior approach was developed in 1908, and requires resection (sawing) of the ribs. A supraclavicular approach (above the collarbone) was developed in 1935, which was less painful than posterior, but more susceptible to nerve damage and fine blood vessels. Due to these difficulties, and because of the crippling sequela associated with sympathetic denervation, conventional or "open" sympathectomy has never been a popular procedure, although it continues to be practiced for hyperhidrosis, Raynaud's disease, and various psychiatric disorders. By popularizing lobotomy in the 1940s, sympathectomy was not favored as a psychosurgical form.
The endoscopic version of the sympathectomy of piston was pioneered by Goren Claes and Christer Drott in Sweden in the late 1980s. The development of "minimally invasive" endoscopic surgical techniques has reduced the recovery time from surgery and increased availability. Today, ETS surgery is practiced in many countries around the world primarily by vascular surgeons.
See also
- Harlequin's Syndrome
References
External links
- University of Maryland Medical Center
- Mayo Clinic
Source of the article : Wikipedia
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