Origianl article
Videothoracoscopic technique in the treatment of autonomic nervous system related disorders

Background: The development of the videothoracoscopic technique was a turning point in modern thoracic surgery, since by using a minimally invasive surgery a good therapeutic effect can be achieved with a minimal risk of complications compared with an open surgery. Aim: The purpose of the study was to assess the results of the treatment for hand hyperhydrosis, arterial disturbances of the upper limbs and pain syndromes caused by advanced neoplasms localised in the epigastrum. Material and methods: From 1993 to June 2004 88 patients underwent 93 thoracoscopic resections of Th2-Th3 sympathetic ganglia and splanchnicectomies. The indication for splanchnicectomy was chronic pain in the epigastrum and for thoracic sympathectomy – hand hyperhydrosis and Raynaud’s syndrome. The result of the treatment for hand hyperhydrosis was evaluated by Monor’s test, for arterial disturbances of the upper limbs by subjective and objective clinical observation and for pain syndromes – using the Prince Henry Hospital Pain Scale (PHHPS). 88 patients were subjected to an analysis during hospitalisation, 26 patients a month after splanchnicectomy and 53 patients from 6 months to four years after thoracic sympathectomy. Results: Patients with epigastric pain syndromes had 2.79, 1.25 and 1.48 points according to the PHHPS before surgery, 24 hours and a month after surgery respectively. In patients that underwent thoracic sympathectomy a very good postoperative therapeutic effect was observed in all cases. Further observation showed that the good therapeutic effect continued only in patients with hand hyperhydrosis. In patients with arterial disturbances of the upper limbs significant alleviation of signs and symptoms persisted in 76% of cases within observation. Conclusions: Thoracoscopic splanchnicectomy and sympathectomy are effective and safe surgical procedures both for patients with chronic epigastric pain syndromes of malignant origin and arterial disturbances of the upper limbs or hand hyperhydrosis.