Endoscopic thoracic sympathectomy

Endoscopic thoracic sympathectomy
Endoscopic thoracic sympathectomy
ICD-9-CM 05.2

Endoscopic thoracic sympathectomy (ETS) is a surgical procedure where certain portions of the sympathetic nerve trunk are destroyed. ETS is used to treat hyperhidrosis, facial blushing, Raynaud's disease and reflex sympathetic dystrophy. By far the most common complaint treated with ETS is palmar hyperhidrosis, or "sweaty palms". In this disorder, the palms may constantly shed so much sweat that the affected person is unable to handle paper, sign documents, keep clothes dry, or shake hands. The result is often social phobia so severe as to be disabling.

Sympathectomy physically destroys some tissue anywhere in either of the two sympathetic trunks, which are long chains of nerve ganglia lying along either side of the spine. Each nerve trunk is broadly divided into three regions: cervical (neck), thoracic (chest), and lumbar (lower back). The most common area targeted in sympathectomy is the upper thoracic region, that part of the sympathetic chain lying between the first and fifth thoracic vertebrae.

In addition to the normal risks of surgery, such as bleeding and infection, sympathectomy has several specific risks, such as adverse changes in how nerves function.



ETS is most commonly used to treat severe hyperhidrosis of the upper body, Raynaud's phenomenon, and facial blushing.

There are reports of ETS being used to achieve cerebral revascularization for patients with moyamoya disease,[1] and to treat headaches, hyperactive bronchial tubes,[2] long QT syndrome[3][4][5] and other conditions.

Thoracic sympathectomy can alter many bodily functions, including sweating,[6] vascular responses,[7] heart rate,[8][9] heart stroke volume,[10][11] thyroid, baroreflex,[12]lung volume,[11][13] pupil dilation, skin temperature, goose bumps and other aspects of the autonomic nervous system, like the fight-or-flight response. It may diminish the body's physical reaction to exercise.[6][11][14]


Sympathectomy involves division of adrenergic, cholinergic and sensory fibers which elaborate adrenergic substances during the process of regulating visceral function.[15] It involves dissection of the main Sympathetic trunk in the upper thoracic region of the sympathetic nervous system, thus interrupting neural messages that ordinarily would travel to many different organs, glands and muscles. It is via these nerves of the autonomic nervous system that the brain is able to make adjustments in the body in response to changing conditions in the environment, changing emotional states, level of exercise, and other factors to maintain the body's homeostasis.

When performed endoscopically, the surgeon penetrates the chest cavity, making holes about the diameter of a straw between ribs. This allows the surgeon to insert the video camera in one hole and a surgical instrument in another.

Sympathectomy is accomplished by dissecting the nerve tissue of the main sympathetic chain. The clamping method, also referred to as endoscopic sympathetic blockade (ESB) employs titanium clamps around the nerve tissue, and was developed in an attempt to make the procedure reversible. However, reversal of the clamping procedure must be performed within a short time after clamping (a few days or weeks at most), and recovery may not be complete.


The most common indication for ETS surgery is hyperhidrosis, or excessive sweating. However, one study on sweating before and one month after ETS demonstrated that the procedure increases total sweat production in a hot sauna.[16]

Swedish National Board of Health and Welfare statement on treatment results says: "A large amount of international studies shows that an incision on the sympatikotomi nerve gives a very positive result when it comes to hand perspiration and also that the side effects are rare."[17] Critics have raised serious questions about the methodology of such studies.[citation needed]

Sympathectomy works by disabling part of the autonomic nervous system, by surgically destroying it, and disrupting the signals to the brain. Many non-ETS doctors find this to be disturbing, as symptoms of the ANS dysfunction go further than the disabled thermoregulation. Sympathectomy prevents the occurrence of a variety of bodily changes, and hence, prevents sensory feedback of those changes.[18][19]

Exact results of ETS are impossible to predict, because of considerable anatomic variations in sympathetic nerve function from one patient to the next, and also because of variations in surgical technique. The autonomic nervous system is not anatomically exact and connections might exist with different parts of the body. This theory has been proven by the fact that a significant number of patients who have had sympathectomy for hand sweating might notice a reduction or elimination of feet sweating. No reliable operation exists for foot sweating per se except lumber sympathectomy.

Lumbar sympathectomy is largely of historical interest today, being reserved for cases of severe sympathetic dystrophy or selected cases of rest pain, where is it usually done by percutaneous ablation of the lumbar sympathetic chain by phenol injection under imaging guidance. Its original use as an operation for lower limb ischaemia has been superseded by direct revascularisation operations or endovascular revacularisation procedures such as angioplasty or angioplasty with stenting of occuded arteries with reasonable runoff i.e. endovascular surgery.

Studies by ETS surgeons have claimed an initial satisfaction rate around 85-95% with at least 2%-19% regretting the surgery and up to 51% of the patients complaining about decreased quality of life.[20][21][22][23] One study shows a satisfaction rate as low as 28.6.[24] Most patients report various adverse reactions as a result of the surgery. However, ETS surgeon Samuel S. Ahn of UCLA claims "100% success with no negative side effects".[25]

A large study of psychiatric patients treated with this surgery showed significant reductions in fear, alertness and arousal. (Teleranta, Pohjavaara, et al. 2003, 2004). Arousal is essential to consciousness, in regulating attention and information processing, memory and emotion.[26] This study also proves what many patients have claimed, that the surgery caused psychological changes. You cannot reduce 'bad' emotional responses, like fear or anxiety. If you reduce emotional responses, they will affect the whole range of emotions and their intensity. With the elimination of the heart rate variability, emotions are also 'capped'.[27]

ETS patients are being studied using the autonomic failure protocol headed by David Goldstein, M.D. Ph.D., senior investigator at the U.S National Institute of Neurological Disorders and Stroke. He has documented loss of thermoregulatory function, cardiac denervation, and loss of vasoconstriction.[28] Recurrence of the original symptoms due to nerve regeneration or nerve sprouting can occur within the first year post surgery, but regeneration can start years after sympathectomy. Nerve sprouting, or abnormal nerve growth after damage or injury to the nerves can cause other further damage. Sprouting sympathtetic nerves can form connections with sensory nerves, and lead to pain conditions that are mediated by the SNS. Every time the system is activated, it is translated into pain. This sprouting and its action can lead to Frey's syndrome, a well recognized after effect of sympathectomy, when the growing sympathetic nerves innervate salivary glands. This leads to excessive sweating when eating. For patients different tastes can trigger this abnormal facial sweating (curiously this happens in the area where people who have undergone this procedure can not sweat any more normally). For some it only occurs with hot food, for others, with hot, sour - even by eating an apple, or sweet. Smelling can also cause abnormal reactions, as the signals get mixed up. Nerve regeneration and subsequent abnormal synapses is a well-documented phenomena.

Some patients have required an artificial pacemaker after developing bradycardia (slow heart beat) as a side effect of the surgery.[29][30][31]

Risks and controversy

No surgery is risk-free, and ETS has both the normal risks of surgery, such as bleeding and infection, and several specific risks, such as changes in how nerves function. Bleeding during and following the operation may be significant in up to 5% of patients.[32] Pneumothorax (collapsed lung) can occur (2% of patients).[32]

Compensatory hyperhidrosis (sweating) is common over the long term, causing 1-2 percent of patients in one review to regret having had the surgery.[32] The rates of severe compensatory sweating vary widely between studies, ranging from as low as 1.2% and as high as 30.9% of patients.[33] Of those patients that develop this side effect, about a quarter said it was major and disabling.[34]

ETS can cause corposcindosis, in which the patient feels like he or she is living in two separate bodies: one half of the body is numb or "dead," and the other half has hyperactive sympathetic nerve function.[33]

The Finnish Office for Health Care Technology Assessment concluded in a 40 page systematic review that Endoscopic Thoracic Sympathectomy is associated with significant immediate and long-term adverse effects.[35]

Quoting the aforementioned (see Results) Swedish National Board of Health and Welfare statement: "The method can give permanent side effects that in some cases first will become obvious after some time. One of the side effects might be increased perspiration on different places on your body. Why and how this happens is still unknown. According to the research available about 25-75% of all patients can expect more or less serious perspiration on different places on their body, such as the trunk and groin area, this is Compensatory sweating.[36]

However, it is also mentioned in the research that 0-10% regret having the surgery done for this reason. Other documented side effects are the inability to raise the heart rate when working out physically. This has in some cases led to decreased ability to perform your work and daily activities. Some patients also complained of not being able to control their body temperature and it is experienced from being very uncomfortable to disabling. However description of a changing sweating pattern does not give a comprehensive picture of the permanently disabled thermoregulation. Consequences of this go far beyond some discomfort wearing damp, in some cases dripping clothes and showing up in public.

A reduced efficiency in maintaining normal body temperature in warm environments is consistent with the reduced ability or complete inability to sweat above the nipple line, a common ETS outcome first shown by Dr. Kotzareff. For a fully clothed person, only the hands, cranial region and neck are typically exposed. In a hot environment, a normal person's body is cooled primarily by evaporation of water vapor through the warmest areas of exposed skin. These areas are associated with the head and neck, which under very warm circumstances or vigorous exercise, visibly show moisture (sweat) accumulating as part of the cooling process. For an ETS patient that has lost ability to sweat from cranium, neck, and arms, an increased amount of body heat must be rejected via transpiration/sweating involving skin of the lower body. Unfortunately, this skin is generally at a lower temperature and usually covered by clothing - both factors that reduce the cooling efficiency and result in poor thermoregulation. An uncomfortably warm sensation and accumulation of sweat on large areas of skin underneath clothing can result. This is one theory on the aetiology of the increased sweating phenomenon after sympathectomy. However one of the pioneers of the procedure, Dr Lin, who performed over 7000 procedures, disputes the compensatory nature of the so called Compensatory Sweating. According to him this is a result of the dysregulated thermoregulation and hypothalamus. He objects to using the "Compensatory" term, he sees as misleading. Postoperative sweating phenomenon is a reflex response between sympathetic system and Hypothalamus. "It is absolutely not a compensatory mechanism. The term of “Reflex sweating” instead of compensatory sweating is used. Hypothalamus is the center of Autonomic Nervous System, which influences human mind, mentality and endocrine system. For this sake, Dr. Lin emphasized, “Endoscopic Sympathetic Surgery helps us open a gate to Autonomic Nervous System”.

There is much disagreement among ETS surgeons about the best surgical method, optimal location for nerve dissection, and as to the nature and extent of the consequent primary effects and side effects. The internet now features many websites run by surgeons extolling the benefits of ETS backed by patient testimonials. However, there are also many websites run by disabled ETS victims who complain of severe adverse reactions and lack of adequate informed consent. Several online discussion forums are dedicated to the subject of ETS surgery, where both positive and negative patient testimonials abound, but considering that this is an elective surgery for a benign condition, even a small number of badly affected number of patients is a high number.

In 2003, ETS was banned in its birthplace, Sweden, due to overwhelming complaints by disabled patients. In 2004, Taiwanese health authorities banned the procedure on patients under 20 years of age. In other countries it is highly unregulated procedure. Although it was never evaluated for safety and adverse effects, sympathectomy is listed on Medical Benefits Scheme, and is freely available to public patients.

In 2006, the FinOHTA group, the Finnish Office for Health Technology Assessment, showed in a review that there were strong indications of side effects as a result of this surgery.[37]

• No systematic reviews, meta-analyses, or clinical trials that evaluated the effectiveness of endoscopic thoracic sympathectomy for treating facial blushing were identified. However, we have identified four case series related to the request (Drott et al. 1998, Rex et al. 1998, Telaranta 1998, Yilmaz et al. 1996). These studies were conducted in three countries (Sweden, Finland and the Netherlands).

• The four case series were not critically appraised because they are prone to bias and have significant methodological problems. These studies represent level IV evidence according to the NHMRC criteria and one should not draw firm conclusions from their findings.

• To date, the benefits or side effects associated with endoscopic thoracic sympathectomy for treating facial blushing have not been properly evaluated and reported. (Omar Ahmed PhD Centre for Clinical Effectiveness Monash Medical Centre Australia)

Other long term adverse effects: Ultrastructural Changes in the Cerebral Artery Wall Induced by Long-Term Sympathetic Denervation[31] Sympathectomy eliminates the psychogalvanic reflex[38] Cervical sympathectomy reduces the heterogeneity of oxygen saturation in small cerebrocortical veins[39] Sympathetic denervation is one of the causes of Mönckeberg's sclerosis[40] T2-3 sympathectomy suppressed baroreflex control of heart rate in the patients with palmar hyperhidrosis. We should note that baroreflex response for maintaining cardiovascular stability is suppressed in the patients who received the ETS.[12] ETS patients should be warned that these mechanisms may play a role in the development of exertional heat stroke.[6] Morphofunctional changes in the myocardium following sympathectomy.[41]

In none of the limbs studied after sympathectomy could an increase in blood flow be produced reflexly by warming; in the majority of instances the opposite response, a decrease in blood flow was observed. One patient with documented transection of the spinal cord above T5 behaved like subjects after surgical sympathectomy.[7] Retarded adaptation of hemodynamics to a sudden start of exercise after sympathectomy. The significant fall in left circumflex coronary flow was proportional to the decline in external heart work due to sympathectomy both at rest and under exercise.[14] Chemical sympathectomy is associated with increased pulmonary metastases.[42]


Sympathectomy developed in the mid-19th century, when it was learned that the autonomic nervous system runs to almost every organ, gland and muscle system in the body. It was surmised that these nerves play a role in how the body regulates many different body functions in response to changes in the environment, exercise and emotion.

The first sympathectomy was performed by Alexander in 1889.[citation needed] Since the sympathetic nervous system was well known to affect many body systems, the surgery was performed in attempts to treat many conditions, including idiocy, goitre, epilepsy, glaucoma, and angina pectoris. Thoracic sympathectomy has been indicated for hyperhidrosis (excessive sweating) since 1920, when Kotzareff showed it would cause anhidrosis (total inability to sweat) from the nipple line upwards.[6][not in citation given]

A lumbar sympathectomy was also developed and used to treat excessive sweating of the feet and other ailments, and typically resulted in impotence in men. Lumbar sympathectomy is still being offered as a treatment for plantar hyperhidrosis, or as a treatment for patients who have a bad outcome (extreme 'compensatory sweating') after thoracic sympathectomy for palmar hyperhidrosis or blushing; extensive sympathectomy risks hypotension.

Sympathectomy itself is relatively easy to perform; however, accessing the nerve tissue in the chest cavity by conventional surgical methods was difficult, painful, and spawned several different approaches. The posterior approach was developed in 1908, and required resection (sawing off) of ribs.[citation needed] A supraclavical (above the collar-bone) approach was developed in 1935, which was less painful than the posterior, but was more prone to damaging important nerves and blood vessels.[citation needed]

Because of these difficulties, and because of disabling sequelae associated with sympathetic denervation, conventional or "open" sympathectomy was never a very popular procedure, although it continued to be practiced for hyperhidrosis, Raynaud's disease, and various psychiatric disorders. With the popularization of lobotomy in the 1940s, sympathectomy fell out of favor as a form of psychosurgery.

The endoscopic version of thoracic sympathectomy was pioneered by Goren Claes and Christer Drott in Sweden in the late 1980s. The development of endoscopic "minimally invasive" surgical techniques have decreased the recovery time from the surgery and increased its popularity. Today, ETS surgery is practiced in many countries throughout the world.

In the late 1990s a group of Swedish ETS patients complaining of disabling side effects formed the organization FFSO (people disabled by sympathectomy). The group grew to over 300 members and their work led to the procedure being banned in Sweden. The two surgeons who pioneered the technique, Drott and Claes, moved their practice from Sweden. They still perform the surgery.

Popular culture

  • The American TV show Grey's Anatomy featured ETS surgery for facial blushing in an episode titled "Make Me Lose Control".[43]

See also

  • Harlequin syndrome


  1. ^ Suzuki J, Takaku A, Kodama N, Sato S (1975). "An attempt to treat cerebrovascular 'Moyamoya' disease in children". Childs Brain 1 (4): 193–206. doi:10.1159/000119568. PMID 1183260. 
  2. ^ Sung SW, Kim JS (March 1999). "Thoracoscopic procedures for intrathoracic and pulmonary diseases". Respirology 4 (1): 19–29. doi:10.1046/j.1440-1843.1999.00146.x. PMID 10339727. http://www3.interscience.wiley.com/journal/119085923/abstract. 
  3. ^ Telaranta T (December 2003). "Psychoneurological applications of endoscopic sympathetic blocks (ESB)". Clin Auton Res. 13 (Suppl 1): I20–1; discussion I21. doi:10.1007/s10286-003-1107-1. PMID 14673667. 
  4. ^ Ventricular Arrhythmia/ Tachycardia
  5. ^ Khan IA (January 2002). "Long QT syndrome: diagnosis and management". Am Heart J. 143 (1): 7–14. doi:10.1067/mhj.2002.120295. PMID 11773906. http://linkinghub.elsevier.com/retrieve/pii/S0002870302249595. 
  6. ^ a b c d Sihoe AD, Liu RW, Lee AK, Lam CW, Cheng LC (September 2007). "Is previous thoracic sympathectomy a risk factor for exertional heat stroke?". Ann Thorac Surg. 84 (3): 1025–7. doi:10.1016/j.athoracsur.2007.04.066. PMID 17720429. http://ats.ctsnetjournals.org/cgi/content/full/84/3/1025. 
  7. ^ a b Redisch W, Tangco FT, Wertheimer L, Lewis AJ, Steele JM (1 April 1957). "Vasomotor responses in the extremities of subjects with various neurologic lesions. I. Reflex responses to warming". Circulation 15 (4): 518–24. PMID 13414070. http://circ.ahajournals.org/cgi/content/abstract/15/4/518. 
  8. ^ Abraham P, Berthelot J, Victor J, Saumet JL, Picquet J, Enon B (December 2002). "Holter changes resulting from right-sided and bilateral infrastellate upper thoracic sympathectomy". Ann Thorac Surg. 74 (6): 2076–81. doi:10.1016/S0003-4975(02)04080-8. PMID 12643398. http://ats.ctsnetjournals.org/cgi/content/full/74/6/2076. 
  9. ^ Abraham P 2002: Fig 1. Histogram (mean ± SEM) of the heart rate before , after right-side, and after bilateral infrastellate sympathectomy.
  10. ^ Chess-Williams RG, Grassby PF, Culling W, Penny W, Broadley KJ, Sheridan DJ (April 1985). "Cardiac postjunctional supersensitivity to beta-agonists after chronic chemical sympathectomy with 6-hydroxydopamine". Naunyn Schmiedebergs Arch. Pharmacol. 329 (2): 162–6. doi:10.1007/BF00501207. PMID 2861571. 
  11. ^ a b c Hashmonai M, Kopelman D (December 2003). "The pathophysiology of cervical and upper thoracic sympathetic surgery". Clin. Auton. Res. 13 (Suppl 1): I40–4. doi:10.1007/s10286-003-1105-3. PMID 14673672. http://www.springerlink.com/content/jrcm3h5k8pye9yyu/. 
  12. ^ a b Kawamata YT, Homma E, Kawamata T, Omote K, Namiki A (2001). "Influence of Endoscopic Thoracic Sympathectomy on Baroreflex Control of Heart Rate in Patients with Palmar Hyperhidrosis". Anesthesiology 95: A160. http://www.asaabstracts.com/strands/asaabstracts/abstract.htm;jsessionid=300DD0D5F41DDA41B7A3AF0625A0CD97?year=2001&index=3&absnum=1370. 
  13. ^ Milner P, Lincoln J, Burnstock G (1998). "The neurochemical organization of the autonomic nervous system". In Appenzeller O, Vinken PJ, Bruyn GW. The autonomic nervous system. [Amsterdam, Netherlands]: Elsevier Science Publishers. pp. 110. ISBN 0-444-82812-5. 
  14. ^ a b Bassenge E, Holtz J, Restorff W Von, Oversohl K (July 1973). "Effect of chemical sympathectomy on coronary flow and cardiovascular adjustment to exercise in dogs". Pflugers Arch. 341 (4): 285–96. doi:10.1007/BF01023670. PMID 4798744. http://www.springerlink.com/content/k2n6j4555g16x773/. 
  15. ^ Cooper T (March 1966). "Surgical sympathectomy and adrenergic function". Pharmacol Rev. 18 (1): 611–8. PMID 5323769. http://pharmrev.aspetjournals.org/cgi/reprint/18/1/611. 
  16. ^ Kopelman D, Assalia A, Ehrenreich M, Ben-Amnon Y, Bahous H, Hashmonai M (2000). "The effect of upper dorsal thoracoscopic sympathectomy on the total amount of body perspiration". Surg. Today 30 (12): 1089–92. doi:10.1007/s005950070006. PMID 11193740. 
  17. ^ English translation of the Swedish statement is here, and the original Swedish text is here.
  18. ^ (see Cervero & Sharkley, 1985)
  19. ^ McNaughton, Neil (1989). Biology and emotion. Cambridge, UK: Cambridge University Press. pp. 67. ISBN 0-521-31938-2. http://books.google.com/?id=-5KpUqb058oC&pg=PA67&lpg=PA67&dq=viscera+sympathectomy. 
  20. ^ Steiner Z, Cohen Z, Kleiner O, Matar I, Mogilner J (March 2008). "Do children tolerate thoracoscopic sympathectomy better than adults?". Pediatr Surg Int. 24 (3): 343–7. doi:10.1007/s00383-007-2073-9. PMID 17999068. 
  21. ^ Choi BC, Lee YC, Sim SB (2003). "Treatment of palmar hyperhidrosis by endoscopic clipping of the upper part of the T4 sympathetic ganglion. Preliminary results". Clin Auton Res. 13 (Suppl 1): I48–51. doi:10.1007/s10286-003-1112-4. PMID 14673674. 
  22. ^ Lardinois D, Ris HB (2002). "Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach". Eur J Cardiothorac Surg 21 (1): 67–70. doi:10.1016/S1010-7940(01)01042-9. PMID 11788259. 
  23. ^ Drott C, Claes G, Olsson-Rex L, Dalman P, Fahlén T, Göthberg G (1998). "Successful treatment of facial blushing by endoscopic transthoracic sympathicotomy". Br J Dermatol. 138 (4): 639–43. doi:10.1046/j.1365-2133.1998.02176.x. PMID 9640370. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0007-0963&date=1998&volume=138&issue=4&spage=639. 
  24. ^ "KoreaMed - Basic Search". http://www.koreamed.org/SearchBasic.php?RID=257346&DT=1&QY=hyperhidrosis+%5BALL%5D. Retrieved 2007-12-02. 
  25. ^ "Sweaty Palms Hereditary". http://www.webmd.com/content/article/18/1685_52932.htm?lastselectedguid=%7B5FE84E90-BC77-4056-A91C-9531713CA348%7D. Retrieved 2007-12-02. 
  26. ^ Social phobia: aetiology, course and treatment with endoscopic sympathetic block (ESB). A qualitative study of the development of social phobia and its meaning in people's lives and a quantitative study of ESB as its treatment
  27. ^ McNaughton, Neil (1989). Biology and emotion. Cambridge, UK: Cambridge University Press. pp. 68. ISBN 0-521-31938-2. http://books.google.com/?id=-5KpUqb058oC&pg=PA67&lpg=PA67&dq=viscera+sympathectomy. 
  28. ^ Moak JP, Eldadah B, Holmes C, Pechnik S, Goldstein DS (June 2005). "Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans". Heart Rhythm 2 (6): 602–9. doi:10.1016/j.hrthm.2005.03.003. PMID 15922266. 
  29. ^ Lai CL, Chen WJ, Liu YB, Lee YT (April 2001). "Bradycardia and permanent pacing after bilateral thoracoscopic T2-sympathectomy for primary hyperhidrosis". Pacing Clin Electrophysiol 24 (4 Pt 1): 524–5. doi:10.1046/j.1460-9592.2001.00524.x. PMID 11341096. http://www3.interscience.wiley.com/journal/119020027/abstract?CRETRY=1&SRETRY=0. 
  30. ^ de Souza Faleiros AT, de Abreu Maffei FH, de Lima Resende LA (2006). "Effects of cervical sympathectomy on vasospasm induced by meningeal haemorrhage in rabbits". Arq. Neuro-Psiquiatr. 64 (3a). doi:10.1590/S0004-282X2006000400006. http://www.scielo.br/scielo.php?pid=S0004-282X2006000400006&script=sci_arttext&tlng=. 
  31. ^ a b Dimitriadou V, Aubineau P, Taxi J, Seylaz J (1988). "Ultrastructural changes in the cerebral artery wall induced by long-term sympathetic denervation". Blood Vessels 25 (3): 122–43. doi:10.1159/000158727. PMID 3359052. http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=000158727&Ausgabe=239141&ProduktNr=224160&filename=000158727.pdf. 
  32. ^ a b c Ojimba, TA; Cameron, AEP (2004). "Drawbacks of endoscopic thoracic sympathectomy". British Journal of Surgery (John Wiley & Sons) 91 (3): 264–269. doi:10.1002/bjs.4511. PMID 14991624. 
  33. ^ a b Dumont P (May 2008). "Side effects and complications of surgery for hyperhidrosis" (PDF). Thorac Surg Clin 18 (2): 193–207. doi:10.1016/j.thorsurg.2008.01.007. PMID 18557592. http://www.truthaboutets.com/Studies/ETS-Complication-PascalDumont.pdf. 
  34. ^ Furlan AD, Mailis A, Papagapiou M (2000). "Are we paying a high price for surgical sympathectomy? A systematic literature review of late complications". J Pain 1 (4): 245–57. doi:10.1054/jpai.2000.19408. PMID 14622605. 
  35. ^ "Effectiveness and safety of endoscopic thoracic sympathectomy". Health Technology Assessment (HTA) Database. Centre for Reviews and Dissemination. http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?View=Full&ID=32005000254. 
  36. ^ Lyra Rde M, Campos JR, Kang DW, Loureiro Mde P, Furian MB, Costa MG, Coelho Mde S; Sociedade Brasileira de Cirurgia Torácica. (2008 November). "Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis.". J Bras Pneumol. 34 (11): 967–77. PMID 19099105. http://www.jornaldepneumologia.com.br/english/artigo_detalhes.asp?id=1257. 
  37. ^ "Reports - Publications - Finohta". http://finohta.stakes.fi/EN/publications/reports/index.htm. Retrieved 2007-12-02. 
  38. ^ Verghese A (May 1968). "Some observations on the psychogalvanic reflex". Br J Psychiatry 114 (510): 639–42. doi:10.1192/bjp.114.510.639. PMID 5654139. http://bjp.rcpsych.org/cgi/content/abstract/114/510/639. 
  39. ^ Wei HM, Sinha AK, Weiss HR (1 April 1993). "Cervical sympathectomy reduces the heterogeneity of oxygen saturation in small cerebrocortical veins". J. Appl. Physiol. 74 (4): 1911–5. PMID 8514710. http://jap.physiology.org/cgi/content/abstract/74/4/1911. 
  40. ^ Goebel FD, Füessl HS (May 1983). "Mönckeberg's sclerosis after sympathetic denervation in diabetic and non-diabetic subjects". Diabetologia 24 (5): 347–50. doi:10.1007/BF00251822. PMID 6873514. http://www.springerlink.com/content/u8412488401j7762/. 
  41. ^ Beskrovnova NN, Makarychev VA, Kiseleva ZM, Legon'kaia, Zhuchkova NI (1984). "[Morphofunctional changes in the myocardium following sympathectomy and their role in the development of sudden death from ventricular fibrillation]" (in Russian). Vestn. Akad. Med. Nauk SSSR (2): 80–5. PMID 6711115. 
  42. ^ Brenner GJ, Felten SY, Felten DL, Moynihan JA (April 1992). "Sympathetic nervous system modulation of tumor metastases and host defense mechanisms". J Neuroimmunol. 37 (3): 191–201. doi:10.1016/0165-5728(92)90003-4. PMID 1313828. 
  43. ^ "Introduction - Corposcindosis". http://www.editthis.info/corposcindosis/Introduction#Grey.27s_Anatomy. Retrieved 2007-12-02. 

External links

Anti-surgery websites
Pro-surgery websites

Wikimedia Foundation. 2010.

Игры ⚽ Нужен реферат?

Look at other dictionaries:

  • Hyperhidrosis — Primary hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature. igns and symptomsHyperhidrosis can either be generalized or localized to specific parts of… …   Wikipedia

  • Compensatory hyperhidrosis — is a form of neuropathy. It is encountered in patients with myelopathy, thoracic disease, cerebrovascular disease, nerve trauma or after surgeries. The exact mechanism of the phenomenon is poorly understood. It is attributed to the perception in… …   Wikipedia

  • List of surgical procedures — Surgical procedures have long and possibly daunting names. The meaning of many surgical procedure names can often be understood if the name is broken into parts. For example in splenectomy, ectomy is a suffix meaning the removal of a part of the… …   Wikipedia

  • Discectomy — Intervention Median sagittal section of two lumbar vertebræ and their ligaments. ( Intervertebral fibrocartilage , an old name for the intervertebral disc, labeled at center left.) ICD 9 CM …   Wikipedia

  • Thoracotomy — Intervention ICD 9 CM 34.02 MeSH …   Wikipedia

  • Neurosurgery — Occupation Activity sectors Surgery Description Education required Doctor of Medicine, Doctor of Osteopathic Med …   Wikipedia

  • Esophagectomy — Intervention ICD 9 CM 42.40 MeSH …   Wikipedia

  • Surgery — This article is about the medical specialty. For other uses, see Surgery (disambiguation). A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. Surgery (from the Greek …   Wikipedia

  • Dacryocystorhinostomy — Intervention Left orbicularis oculi, seen from behind. ICD 9 CM …   Wikipedia

  • Magnetic resonance neurography — Bilateral Split Sciatic Nerve Magnetic resonance neurography (MRN) is the direct imaging of nerves in the body by optimizing selectivity for unique MRI water properties of nerves. It is a modification of magnetic resonance imaging. This technique …   Wikipedia

Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”