Minimally invasive surgery for sympathetic nervous system disorders

This thesis evaluates the outcome of a minimally invasive thoracic operative technique for performing a surgical interruption of sympathetic signals, needing only one surgical access point per side. This technique and its long- and short-term outcomes are evaluated in patients suffering from severe palmar and/or axillary excessive sweating (hyperhidrosis), facial blushing, Raynaud's phenomenon or to palliate abdominal pain following chronic pancreatitis.

In an adult focal hyperhidrosis population, this procedure proves highly effective and without major side-effects, especially in the palmar subgroup. Results in minors and children are less promising due to a substantial higher recurrence of symptoms. A slightly modified approach is performed in patients with severe facial blushing, staging the procedure. Here also high satisfaction rates are obtained. In patients with Raynaud's phenomenon, a vasospastic disorder typically targeting the hand and feet, a clear benefit in perceived as well in objectively measured palmar perfusion is seen. This effect is most pronounced in the short term but remains significant after 12 months. Longer term studies are currently underway.

Finally, the first ever case series of single-port splanchnotomy is described in patients with chronic pancreatitis refractory to more conventional therapy. A significant reduction in pain perceived by these patients is observed.