Simpatectomia cervicotoracica por videotoracoscopia: experiência inicial

Kauffman, Paulo; Milanez, José Ribas Campo; Jatene, Fábio Biscegli; Leão, Pedro Puech

doi:10.1590/S0100-69911998000400004

Resumos

O objetivo do presente trabalho é avaliar os resultados iniciais obtidos com a simpatectomia cervicotorácica videotoracoscópica. De outubro de 1995 a outubro de 1997 foram realizados 24 procedimentos em 14 pacientes: dez homens e quatro mulheres, com idades que variaram de 16 a 56 anos, média de 30 anos. Indicações para a operação foram: hiperidrose palmar em dez pacientes, isquemia de mão em três e causalgia em um. Nos casos de hiperidrose, a ressecção da cadeia simpática incluiu T2 e T3. Nos portadores de isquemia e causalgia também o gânglio estrelado foi ressecado. Vinte e três das 24 extremidades mostraram excelente resposta imediata à simpatectomia. Somente uma extremidade de paciente com hiperidrose permaneceu inalterada devido a procedimento incompleto, tendo sido desnervada pela mesma técnica em reoperação posterior, com bom resultado. Pneumotórax residual pós-operatório ocorreu em uma paciente com resolução espontânea. Treze pacientes tiveram seguimento que variou de dois a 18 meses, com média de 11 meses. Não houve mortalidade nessa série, e a principal complicação tardia observada nos pacientes operados por hiperidrose foi a hiperidrose compensatória, que ocorreu, em grau variado, nos nove pacientes com seguimento, sendo que em 30% deles esta manifestação foi significativa. Concluímos tratar-se de procedimento simples, seguro, eficiente e de melhor aceitação por parte dos pacientes do que a operação convencional.

Simpatectomia cervicotorácica; Toracoscopia; Simpatectomia toracoscópica; Hiperidrose palmar

This report analyzes the initial results of thoracoscopic cervicodorsal sympathectomy. From October 1995 to October 1997, 24 procedures were accomplished in 14 patients. Ten were males and four were females ranging in age from 16 to 56 (mean 30). Surgical indications were: palmar hyperhidrosis in ten, ischemia of the hand in three and causalgia in one. Resection of the sympathetic chain in hyperhidrosis included T2 and T3. In those with ischemia and causalgia the stellate ganglion was also resected. The imediate results of sympathectomy were excellent in twenty-three of the extremities. Only one extremity with hyperhidrosis remained unchanged due to an incomplete procedure. The same technique was used in a later reoperation with good results. There was one case of residual postoperative pneumothorax which recovered spontaneously. Thirteen patients were followed from two to eighteen months (mean 11 months). Mortality was null in this series. The main late complication in patients operated on for hyperhidrosis was compensatory hyperhidrosis which occurred in various degrees in the nine patients followed-up. The latter was significant in 30%. The authors consider this a simple, safe, effective procedure which is more acceptable by patients than conventional surgery.

Cervocothoracic sympathectomy; Thoracoscopy; Thoracoscopic sympathectomy; Palmar hyperhidrosis

ARTIGOS ORIGINAIS

Simpatectomia cervicotoracica por videotoracoscopia: experiência inicial

Thoracoscopic cervicodorsal sympathectomy: initial results

Paulo Kauffman, TCBC-SP^I; José Ribas Campo Milanez^II; Fábio Biscegli Jatene, ACBC-SP^III; Pedro Puech Leão, ACBC-SP^IV

^IProfessor Assistente Doutor da Disciplina de Cirurgia Vascular

^IIAssistente Doutor da Disciplina de Cirurgia Torácica

^IIIChefe da Disciplina de Cirurgia Torácica do HC-INCOR. Doutor pela FMUSP

^IVProfessor Titular da Disciplina de Cirurgia Vascular

^{Endereço para correspondência} Endereço para correspondência: Dr. Paulo Kauffrnan Rua Espéria, 30 01433-060 - São Paulo - SP

RESUMO

O objetivo do presente trabalho é avaliar os resultados iniciais obtidos com a simpatectomia cervicotorácica videotoracoscópica. De outubro de 1995 a outubro de 1997 foram realizados 24 procedimentos em 14 pacientes: dez homens e quatro mulheres, com idades que variaram de 16 a 56 anos, média de 30 anos. Indicações para a operação foram: hiperidrose palmar em dez pacientes, isquemia de mão em três e causalgia em um. Nos casos de hiperidrose, a ressecção da cadeia simpática incluiu T2 e T3. Nos portadores de isquemia e causalgia também o gânglio estrelado foi ressecado. Vinte e três das 24 extremidades mostraram excelente resposta imediata à simpatectomia. Somente uma extremidade de paciente com hiperidrose permaneceu inalterada devido a procedimento incompleto, tendo sido desnervada pela mesma técnica em reoperação posterior, com bom resultado. Pneumotórax residual pós-operatório ocorreu em uma paciente com resolução espontânea. Treze pacientes tiveram seguimento que variou de dois a 18 meses, com média de 11 meses. Não houve mortalidade nessa série, e a principal complicação tardia observada nos pacientes operados por hiperidrose foi a hiperidrose compensatória, que ocorreu, em grau variado, nos nove pacientes com seguimento, sendo que em 30% deles esta manifestação foi significativa. Concluímos tratar-se de procedimento simples, seguro, eficiente e de melhor aceitação por parte dos pacientes do que a operação convencional.

Unitermos: Simpatectomia cervicotorácica; Toracoscopia; Simpatectomia toracoscópica; Hiperidrose palmar.

ABSTRACT

This report analyzes the initial results of thoracoscopic cervicodorsal sympathectomy. From October 1995 to October 1997, 24 procedures were accomplished in 14 patients. Ten were males and four were females ranging in age from 16 to 56 (mean 30). Surgical indications were: palmar hyperhidrosis in ten, ischemia of the hand in three and causalgia in one. Resection of the sympathetic chain in hyperhidrosis included T2 and T3. In those with ischemia and causalgia the stellate ganglion was also resected. The imediate results of sympathectomy were excellent in twenty-three of the extremities. Only one extremity with hyperhidrosis remained unchanged due to an incomplete procedure. The same technique was used in a later reoperation with good results. There was one case of residual postoperative pneumothorax which recovered spontaneously. Thirteen patients were followed from two to eighteen months (mean 11 months). Mortality was null in this series. The main late complication in patients operated on for hyperhidrosis was compensatory hyperhidrosis which occurred in various degrees in the nine patients followed-up. The latter was significant in 30%. The authors consider this a simple, safe, effective procedure which is more acceptable by patients than conventional surgery.

Key words: Cervocothoracic sympathectomy; Thoracoscopy; Thoracoscopic sympathectomy; Palmar hyperhidrosis.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

REFERÊNCIAS

1. Kux E. The endoscopic approach to the vegetative nervous system and its terapeutic possibilities. Dis Chest 1951;20: 139 - 147.

2. Kux M. Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis. Arch Surg 1978; 113: 264 - 266.

3. Weale FE. Upper thoracic sympathectomy by transthoracic electrocoagulation. Br J Surg 1980; 67: 71-72.

4. Malone PS, Duignan JP, Hederman WP - Transthoracic electrocoagulation: a new and simple approach to upper limb sympathectomy. Ir Med J 1982; 75: 20 -21.

5. Milewski PJ, Hodgson SP, Higham A. Transthoracic endoscopic sympathectomy. J R Coll Surg Edinb 1985; 30: 2201-223.

6. Malone PS, Cameron AEP, Rennie JA. The surgical treatment of upper limb hyperhidrosis. Br J Dermat 1986; 115: 81- 84.

7. Banerjee AK, Edmonson R, Rennie JA. Endoscopic transthoracic electrocautery of the sympathetic chain for palmar and axillary hyperhidrosis. Br J Surg 1990; 77: 1.435-1.436.

8. Lin CC. A new method of thoracoscopic sympathectomy in hyperhidrosis palmaris. Surg Endosc 1990; 4: 224-226.

9. Byrne J, Walsh TN, Hederman WP. Endoscopic transthoracic electocautery of the sympathetic chain for palmar and axillary hyperhidrosis. Br J Surg 1990; 77:1.046-1.049.

10. Adams DCR, Poskitt KR. Surgical management of primary hyperhidrosis. Br J Surg 1991;78:1.019-1.020.

11. Edmonson RA, Banerjee AK, Rennie JA. Endoscopic transthoracic sympathectomy in the treatment of hyperhidrosis. Ann Surg 1992; 215:289-293.

12. Kao M. Videoendoscopic sympathectomy using a fiberoptic CO, laser to treat palmar hyperhidrosis. Neurosurgery 1992; 30:131-135.

13. Claes G, Gothberg G, Drott C. Endoscopic electrocautery of the thoracic sympathetic chain: a minimally invasive method to treat palmar hyperhidrosis. Scand J Plast Recontr Surg Hand Surg 1993; 27:29-33.

14. Drott C, Gothberg G, Claes G. Endoscopic procedures of the upper thoracic sympathetic chain: a review. Arch Surg 1993;128: 237- 241.

15. Herbst F. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. Ann Surg 1994;220:86-90.

16. Hederman WP. Present and future trends in thoracoscopic sympathectomy. Eur J Surg ( Suppl.) 1994;572:17-19.

17.Schachor D, Jedeikin R, Olsfanger D, et al. Endoscopic transthoracic sympathectomy in the treatment of primary hyperhidrosis. Arch Surg 1994;129:241-244.

18. Hashmonai M, Kopelman D, Schein M. Thoracoscopic versus open supraclavicular upper dorsal sympathectomy: a prospective randomised trial. Eur J Surg ( Suppl.) 1994;572: 13-16.

19. Sayers RD, Jenner RE, Barrie WW. Transthoracic endoscopic sympathectomy for hyperhidrosis and Raynaud's phenomenon. Eur J Vasc Surg 1994;8:627-631.

20. Gothberg G, Drott C, Claes G. Thoracoscopic sympathicotomy for hyperhidrosis: surgical technique, complications and side effects. Eur J Surg (Suppl.) 1994;572:5-7.

21. Chen HJ, Shih DY, Fung ST. Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis. Arch Surg 1994;129: 630-633.

22. Ishibashi H, Hayakawa N, Yamamoto H, et al. Thoracoscopic sympathectomy for Buerger's disease: a report on the successful treatment of four patients. Surg-Today 1995;25:180-183.

23. Leseche G, Nicolet J, Andreassian B. Traitement de l"hyperhidrose primitive des membres supérieurs par sympathectomie endoscopique transthoracique. La Presse Medicale 1995;24: 1.569-1.573.

24. Gossot D. Sympathectomie sélective endoscopique pour hyperhidrose palmaire. La Presse Medicale1995;24:1.739-1.742.

25. Kopelman D, Hashmonai M, Ehrenreich M, et al. Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis: improved intermediate-term results. J Vasc Surg 1996; 24:194-199.

26. Lee KH, Hwang PYK. Video endoscopic sympathectomy for palmar hyperhidrosis. J Neurosurg 1996; 84:484-486.

27 . Kao MC, Lin JY, Chen YL, et al. Minimally invasive surgery : Video endoscopic thoracic sympathectomy for palmar hyperhidrosis. Ann Acad Med Singapore 1996;25:673-678.

28. Gossot D, Toledo L, Fritsch S, Célérier M. Thoracoscopic sympathectomy for upper limb hyperhidrosis: looking for the right operation. Ann Thorac Surg 1997;64:975-978.

29. Ahn SS, Machleder HI, Concepcion B, Moore WS. Thoracoscopic cervicodorsal sympathectomy: preliminary results. J Vasc Surg 1994; 20:511-519.

30. Josephs LG, Menzoian JO. Technical considerations in endoscopic cervicothoracic sympathectomy. Arch Surg 1996;131:355-359.

31. Wettervik C, Claes G, Drott C, et al. Endoscopic transthoracic sympathicotomy for severe angina. Lancet 1995;345:97-98.

32. Kao MC, Chen YL, Lin JY, et al. Endoscopic sympathectomy treatment for craniofacial hyperhidrosis. Arch Surg 1996;131:1.091-1.094.

33. Nicholson ML, Dennis MJ, Hopkinson BR. Endoscopic transthoracic sympathectomy successful in hyperhidrosis but can the indications be extended? Ann R Coll Surg Engl 1994;76:311-314.

34. Telford ED. Technique of sympathectomy. Br J Surg 1935;23: 448-50.

35. Cloward R. Hyperidrosis. J Neurosurg 1969;30:545-551.

36. Jochimsen PR, Hartfall WG. Per axillary upper extremity sympathectomy. Technique rewied and clinical experience. Surgery 1972; 71:686-693.

37. Koikkalainen K, Luosto R, Keskitalo E, Melartin E. Upper limb sympathectomy. Ann Chir Gynaec Fenn 1974; 63:318-325.

38. Kauffman P, Cinelli Jr. M, Wolosker M, Puech Leão LE. Tratamento da hiperidrose palmar pela simpatectomia cérvico-torácica. Rev Ass Med Bras 1978;24:29-30.

39. Wolosker M, Kauffman P, Manasterski J, et al. A simpatectomia cérvico-torácica no tratamento das isquemias crônicas dos membros superiores. Rev Ass Med Brasil 1980;26:403-406.

40. Greenhalgh RM, Rosengarten DS, Martin P. Role of sympathectomy for hyperhidrosis. Br Med J 1971; I :332-334.

41. Keaveny TV, Fitzpatrick J, Fitzgerald PA. The surgical treatment of hyperhidrosis. J Irish Med Ass 1974;67:544-545.

42. Gjerris F, Olesen HP. Palmar hyperhidrosis. Long -term results following high thoracic sympathectomy. Acta Neurol Scand 1975;51:167-172.

43. Hashmonai M, Kopelman D, Schein M. Thoracoscopic versus open supraclavicular upper dorsal sympathectomy: a prospective randomised trial. Eur J Surg (Suppl.)1994;572:13-16.

44. Adar R. Surgical treatment of palmar hyperhidrosis before thoracoscopy: experience with 475 patients. Eur J Surg (Suppl) 1994; 572: 9-11.

Recebido em 9/12/9

Aceito para publicação em 16/4/98

Trabalho realizado nas Disciplinas de Cirurgia Vascular e Torácica do Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo.

1. Kux E. The endoscopic approach to the vegetative nervous system and its terapeutic possibilities. Dis Chest 1951;20: 139 - 147.
2. Kux M. Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis. Arch Surg 1978; 113: 264 - 266.
3. Weale FE. Upper thoracic sympathectomy by transthoracic electrocoagulation. Br J Surg 1980; 67: 71-72.
4. Malone PS, Duignan JP, Hederman WP - Transthoracic electrocoagulation: a new and simple approach to upper limb sympathectomy. Ir Med J 1982; 75: 20 -21.
5. Milewski PJ, Hodgson SP, Higham A. Transthoracic endoscopic sympathectomy. J R Coll Surg Edinb 1985; 30: 2201-223.
6. Malone PS, Cameron AEP, Rennie JA. The surgical treatment of upper limb hyperhidrosis. Br J Dermat 1986; 115: 81- 84.
7. Banerjee AK, Edmonson R, Rennie JA. Endoscopic transthoracic electrocautery of the sympathetic chain for palmar and axillary hyperhidrosis. Br J Surg 1990; 77: 1.435-1.436.
8. Lin CC. A new method of thoracoscopic sympathectomy in hyperhidrosis palmaris. Surg Endosc 1990; 4: 224-226.
9. Byrne J, Walsh TN, Hederman WP. Endoscopic transthoracic electocautery of the sympathetic chain for palmar and axillary hyperhidrosis. Br J Surg 1990; 77:1.046-1.049.
10. Adams DCR, Poskitt KR. Surgical management of primary hyperhidrosis. Br J Surg 1991;78:1.019-1.020.
11. Edmonson RA, Banerjee AK, Rennie JA. Endoscopic transthoracic sympathectomy in the treatment of hyperhidrosis. Ann Surg 1992; 215:289-293.
12. Kao M. Videoendoscopic sympathectomy using a fiberoptic CO, laser to treat palmar hyperhidrosis. Neurosurgery 1992; 30:131-135.
13. Claes G, Gothberg G, Drott C. Endoscopic electrocautery of the thoracic sympathetic chain: a minimally invasive method to treat palmar hyperhidrosis. Scand J Plast Recontr Surg Hand Surg 1993; 27:29-33.
14. Drott C, Gothberg G, Claes G. Endoscopic procedures of the upper thoracic sympathetic chain: a review. Arch Surg 1993;128: 237- 241.
15. Herbst F. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. Ann Surg 1994;220:86-90.
16. Hederman WP. Present and future trends in thoracoscopic sympathectomy. Eur J Surg ( Suppl.) 1994;572:17-19.
17.Schachor D, Jedeikin R, Olsfanger D, et al. Endoscopic transthoracic sympathectomy in the treatment of primary hyperhidrosis. Arch Surg 1994;129:241-244.
18. Hashmonai M, Kopelman D, Schein M. Thoracoscopic versus open supraclavicular upper dorsal sympathectomy: a prospective randomised trial. Eur J Surg ( Suppl.) 1994;572: 13-16.
19. Sayers RD, Jenner RE, Barrie WW. Transthoracic endoscopic sympathectomy for hyperhidrosis and Raynaud's phenomenon. Eur J Vasc Surg 1994;8:627-631.
20. Gothberg G, Drott C, Claes G. Thoracoscopic sympathicotomy for hyperhidrosis: surgical technique, complications and side effects. Eur J Surg (Suppl.) 1994;572:5-7.
21. Chen HJ, Shih DY, Fung ST. Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis. Arch Surg 1994;129: 630-633.
22. Ishibashi H, Hayakawa N, Yamamoto H, et al. Thoracoscopic sympathectomy for Buerger's disease: a report on the successful treatment of four patients. Surg-Today 1995;25:180-183.
23. Leseche G, Nicolet J, Andreassian B. Traitement de l"hyperhidrose primitive des membres supérieurs par sympathectomie endoscopique transthoracique. La Presse Medicale 1995;24: 1.569-1.573.
24. Gossot D. Sympathectomie sélective endoscopique pour hyperhidrose palmaire. La Presse Medicale1995;24:1.739-1.742.
25. Kopelman D, Hashmonai M, Ehrenreich M, et al. Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis: improved intermediate-term results. J Vasc Surg 1996; 24:194-199.
26. Lee KH, Hwang PYK. Video endoscopic sympathectomy for palmar hyperhidrosis. J Neurosurg 1996; 84:484-486.
27 . Kao MC, Lin JY, Chen YL, et al. Minimally invasive surgery : Video endoscopic thoracic sympathectomy for palmar hyperhidrosis. Ann Acad Med Singapore 1996;25:673-678.
28. Gossot D, Toledo L, Fritsch S, Célérier M. Thoracoscopic sympathectomy for upper limb hyperhidrosis: looking for the right operation. Ann Thorac Surg 1997;64:975-978.
29. Ahn SS, Machleder HI, Concepcion B, Moore WS. Thoracoscopic cervicodorsal sympathectomy: preliminary results. J Vasc Surg 1994; 20:511-519.
30. Josephs LG, Menzoian JO. Technical considerations in endoscopic cervicothoracic sympathectomy. Arch Surg 1996;131:355-359.
31. Wettervik C, Claes G, Drott C, et al. Endoscopic transthoracic sympathicotomy for severe angina. Lancet 1995;345:97-98.
32. Kao MC, Chen YL, Lin JY, et al. Endoscopic sympathectomy treatment for craniofacial hyperhidrosis. Arch Surg 1996;131:1.091-1.094.
33. Nicholson ML, Dennis MJ, Hopkinson BR. Endoscopic transthoracic sympathectomy successful in hyperhidrosis but can the indications be extended? Ann R Coll Surg Engl 1994;76:311-314.
34. Telford ED. Technique of sympathectomy. Br J Surg 1935;23: 448-50.
35. Cloward R. Hyperidrosis. J Neurosurg 1969;30:545-551.
36. Jochimsen PR, Hartfall WG. Per axillary upper extremity sympathectomy. Technique rewied and clinical experience. Surgery 1972; 71:686-693.
37. Koikkalainen K, Luosto R, Keskitalo E, Melartin E. Upper limb sympathectomy. Ann Chir Gynaec Fenn 1974; 63:318-325.
38. Kauffman P, Cinelli Jr. M, Wolosker M, Puech Leăo LE. Tratamento da hiperidrose palmar pela simpatectomia cérvico-torácica. Rev Ass Med Bras 1978;24:29-30.
39. Wolosker M, Kauffman P, Manasterski J, et al. A simpatectomia cérvico-torácica no tratamento das isquemias crônicas dos membros superiores. Rev Ass Med Brasil 1980;26:403-406.
40. Greenhalgh RM, Rosengarten DS, Martin P. Role of sympathectomy for hyperhidrosis. Br Med J 1971; I :332-334.
41. Keaveny TV, Fitzpatrick J, Fitzgerald PA. The surgical treatment of hyperhidrosis. J Irish Med Ass 1974;67:544-545.
42. Gjerris F, Olesen HP. Palmar hyperhidrosis. Long -term results following high thoracic sympathectomy. Acta Neurol Scand 1975;51:167-172.
43. Hashmonai M, Kopelman D, Schein M. Thoracoscopic versus open supraclavicular upper dorsal sympathectomy: a prospective randomised trial. Eur J Surg (Suppl.)1994;572:13-16.
44. Adar R. Surgical treatment of palmar hyperhidrosis before thoracoscopy: experience with 475 patients. Eur J Surg (Suppl) 1994; 572: 9-11.

Endereço para correspondência:

Dr. Paulo Kauffrnan

Rua Espéria, 30

01433-060 - São Paulo - SP

Datas de Publicação

Publicação nesta coleção
23 Jul 2010
Data do Fascículo
Ago 1998

Histórico

Recebido
09 Dez 1998
Aceito
16 Abr 1998

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Kux E. The endoscopic approach to the vegetative nervous system and its terapeutic possibilities. Dis Chest 1951;20: 139 - 147.

[2] 2. Kux M. Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis. Arch Surg 1978; 113: 264 - 266.

[3] 3. Weale FE. Upper thoracic sympathectomy by transthoracic electrocoagulation. Br J Surg 1980; 67: 71-72.

[4] 4. Malone PS, Duignan JP, Hederman WP - Transthoracic electrocoagulation: a new and simple approach to upper limb sympathectomy. Ir Med J 1982; 75: 20 -21.

[5] 5. Milewski PJ, Hodgson SP, Higham A. Transthoracic endoscopic sympathectomy. J R Coll Surg Edinb 1985; 30: 2201-223.

[6] 6. Malone PS, Cameron AEP, Rennie JA. The surgical treatment of upper limb hyperhidrosis. Br J Dermat 1986; 115: 81- 84.

[7] 7. Banerjee AK, Edmonson R, Rennie JA. Endoscopic transthoracic electrocautery of the sympathetic chain for palmar and axillary hyperhidrosis. Br J Surg 1990; 77: 1.435-1.436.

[8] 8. Lin CC. A new method of thoracoscopic sympathectomy in hyperhidrosis palmaris. Surg Endosc 1990; 4: 224-226.

[9] 9. Byrne J, Walsh TN, Hederman WP. Endoscopic transthoracic electocautery of the sympathetic chain for palmar and axillary hyperhidrosis. Br J Surg 1990; 77:1.046-1.049.

[10] 10. Adams DCR, Poskitt KR. Surgical management of primary hyperhidrosis. Br J Surg 1991;78:1.019-1.020.

[11] 11. Edmonson RA, Banerjee AK, Rennie JA. Endoscopic transthoracic sympathectomy in the treatment of hyperhidrosis. Ann Surg 1992; 215:289-293.

[12] 12. Kao M. Videoendoscopic sympathectomy using a fiberoptic CO, laser to treat palmar hyperhidrosis. Neurosurgery 1992; 30:131-135.

[13] 13. Claes G, Gothberg G, Drott C. Endoscopic electrocautery of the thoracic sympathetic chain: a minimally invasive method to treat palmar hyperhidrosis. Scand J Plast Recontr Surg Hand Surg 1993; 27:29-33.

[14] 14. Drott C, Gothberg G, Claes G. Endoscopic procedures of the upper thoracic sympathetic chain: a review. Arch Surg 1993;128: 237- 241.

[15] 15. Herbst F. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. Ann Surg 1994;220:86-90.

[16] 16. Hederman WP. Present and future trends in thoracoscopic sympathectomy. Eur J Surg ( Suppl.) 1994;572:17-19.

[17] 17.Schachor D, Jedeikin R, Olsfanger D, et al. Endoscopic transthoracic sympathectomy in the treatment of primary hyperhidrosis. Arch Surg 1994;129:241-244.

[18] 18. Hashmonai M, Kopelman D, Schein M. Thoracoscopic versus open supraclavicular upper dorsal sympathectomy: a prospective randomised trial. Eur J Surg ( Suppl.) 1994;572: 13-16.

[19] 19. Sayers RD, Jenner RE, Barrie WW. Transthoracic endoscopic sympathectomy for hyperhidrosis and Raynaud's phenomenon. Eur J Vasc Surg 1994;8:627-631.

[20] 20. Gothberg G, Drott C, Claes G. Thoracoscopic sympathicotomy for hyperhidrosis: surgical technique, complications and side effects. Eur J Surg (Suppl.) 1994;572:5-7.

[21] 21. Chen HJ, Shih DY, Fung ST. Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis. Arch Surg 1994;129: 630-633.

[22] 22. Ishibashi H, Hayakawa N, Yamamoto H, et al. Thoracoscopic sympathectomy for Buerger's disease: a report on the successful treatment of four patients. Surg-Today 1995;25:180-183.

[23] 23. Leseche G, Nicolet J, Andreassian B. Traitement de l"hyperhidrose primitive des membres supérieurs par sympathectomie endoscopique transthoracique. La Presse Medicale 1995;24: 1.569-1.573.

[24] 24. Gossot D. Sympathectomie sélective endoscopique pour hyperhidrose palmaire. La Presse Medicale1995;24:1.739-1.742.

[25] 25. Kopelman D, Hashmonai M, Ehrenreich M, et al. Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis: improved intermediate-term results. J Vasc Surg 1996; 24:194-199.

[26] 26. Lee KH, Hwang PYK. Video endoscopic sympathectomy for palmar hyperhidrosis. J Neurosurg 1996; 84:484-486.

[27] 27 . Kao MC, Lin JY, Chen YL, et al. Minimally invasive surgery : Video endoscopic thoracic sympathectomy for palmar hyperhidrosis. Ann Acad Med Singapore 1996;25:673-678.

[28] 28. Gossot D, Toledo L, Fritsch S, Célérier M. Thoracoscopic sympathectomy for upper limb hyperhidrosis: looking for the right operation. Ann Thorac Surg 1997;64:975-978.

[29] 29. Ahn SS, Machleder HI, Concepcion B, Moore WS. Thoracoscopic cervicodorsal sympathectomy: preliminary results. J Vasc Surg 1994; 20:511-519.

[30] 30. Josephs LG, Menzoian JO. Technical considerations in endoscopic cervicothoracic sympathectomy. Arch Surg 1996;131:355-359.

[31] 31. Wettervik C, Claes G, Drott C, et al. Endoscopic transthoracic sympathicotomy for severe angina. Lancet 1995;345:97-98.

[32] 32. Kao MC, Chen YL, Lin JY, et al. Endoscopic sympathectomy treatment for craniofacial hyperhidrosis. Arch Surg 1996;131:1.091-1.094.

[33] 33. Nicholson ML, Dennis MJ, Hopkinson BR. Endoscopic transthoracic sympathectomy successful in hyperhidrosis but can the indications be extended? Ann R Coll Surg Engl 1994;76:311-314.

[34] 34. Telford ED. Technique of sympathectomy. Br J Surg 1935;23: 448-50.

[35] 35. Cloward R. Hyperidrosis. J Neurosurg 1969;30:545-551.

[36] 36. Jochimsen PR, Hartfall WG. Per axillary upper extremity sympathectomy. Technique rewied and clinical experience. Surgery 1972; 71:686-693.

[37] 37. Koikkalainen K, Luosto R, Keskitalo E, Melartin E. Upper limb sympathectomy. Ann Chir Gynaec Fenn 1974; 63:318-325.

[38] 38. Kauffman P, Cinelli Jr. M, Wolosker M, Puech Leăo LE. Tratamento da hiperidrose palmar pela simpatectomia cérvico-torácica. Rev Ass Med Bras 1978;24:29-30.

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