Thoracic Sympathectomy for Palmar Hyperhidrosis

Aaradhya Sharma

https://www.laparoscopyhospital.com/SERV01.HTM  This is a case of Thoracic Sympathectomy for Palmar Hyperhidrosis performed at World Laparoscopy Hospital. Deep inside your chest, a structure called the sympathetic nerve chain runs up and down along your spine. It is the part of the nervous system responsible for the fight or flight response. During a sympathectomy, a surgeon cuts or this nerve chain. This keeps nerve signals from passing through it. This procedure is used to treat a condition called hyperhidrosis or abnormally heavy sweating in the palms of the hands, the face, the underarms, and sometimes the feet. It's also used for facial blushing, some chronic pain conditions, and the Raynaud phenomenon — a condition that leads to profound sensitivity to cold temperatures and color changes of the skin. After a sympathectomy, the brain can't send signals to the involved areas to make them sweat, blush, or react to the cold as much. This permanent procedure is used as a last resort if other steps, such as antiperspirants or medicines, haven't worked.   For more information: https://www.laparoscopyhospital.com  For more information please contact: World Laparoscopy Hospital Cyber City, Gurugram NCR Delhi INDIA 122002  Phone & WhatsApp: +919811416838, + 91 9999677788

Transcript

00:00Hello friends this is a case of thoracic sympathetic tommy which we are performing

00:06for palmer hyperhidrosis here on the fourth intercostal space fourth or fifth both you

00:12can use interior auxiliary line this is optical port this is 5 millimeter port and here we

00:18are using 5 millimeter striker 4 k telescope that is a very good quality telescope and

00:26we will use 1688 striker camera and now on the mid clavicular line this is the second

00:32intercostal space that will be used for the instrument to use energy and you can use hook

00:39there to cut the sympathetic now here we will use the t 3 because t 2 is the first visible

00:48vertebra by the lap thoracoscopy and because only palmer hyperhidrosis is there.

00:55So, this t 3 will be cut with the hook and this is a monopolar hook which is cutting the

01:03t 3 this is proximal end of the nerve cutting current should be used and minimum wattage

01:14should be used. So, that cervicothoracic ganglion should not be damaged by remote injury and now,

01:21laterally 4 5 centimeter you should cut the mediation pleura and check for any other collateral

01:28ramus or duplicate nerve that is important to find out because once you sometime collateral

01:35and duplicate nerves are there. So, it is better to cut it if periosteum will burn patient

01:47will have little backache transiently, but that will be within couple of days. So, now this

01:54side is over and now you can go to the opposite side here we are doing the bilateral sympatectomy

02:01so that both the side it will work and then this is the right side and these are the ribs

02:14and again you can find out the sympathetic nerve and then you can separate the nerve with the

02:22monopolar you can cut it and then 3 4 centimeter lateral you can separate the mediation pleura

02:32and you can check for any duplicate nerve on collateral ramus. So, this is very simple surgery

02:39that is thoracic sympathectomy. Now, once it is over after that in front of your telescope

02:46you should inflate the lung you should ask your anesthetist to give the complete tidal volume

02:52and slowly slowly telescope should be withdrawn and in front of you you should inflate the

02:57lung so that it should not remain collapse. So, thank you very much for watching this video

03:05this was just a simple case of thoracic sympathectomy for the palmer hyperhidrosis in a young patient,

03:13patient was only 21 year old and he was suffering from severe hyperhidrosis. Thank you very much.

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