Historically, sympathectomy has been employed in the treatment of a variety of disparate disorders, although in many there is little if any objective,controled evidence of its efficacy. Sympathectomy at the level of the upper dorsal chain however is highly effective in the permanent treatment of essential hyperhidrosis at the facial (including for flushing), palmar and axillar level; it is effective in selected patients with true major causalgia, and with vasospastic or isschaemic vascular disease (thoracic outlet syndrome, arterial isschaemia, Buerger disease), and in selected patients with refractory angina pectoris, long QT syndrome, Prinzmetal’s angina, paroxysmal atrial and ventricular tachycardia. Sympathectomy at the lower dorsal (splanchnic) level may be effective in the treatment of refractory pancreatic pain.
Dorsal or splanchnic sympathectomy or sympathicolysis is currently most easily achieved, with equal efficacy and inferior morbidity as compared to open surgery, using thoracoscopic ablation techniques. ”Classical” VATS resection, NdYAG laser ablation, electrocautery medical thoracoscopic sympathicolysis, ”needle” thoracoscopy, and other techniques are chosen pending the personal experience and preference of the operator, no studies comparing the various techniques being available. Techniques, complications, (side) effects on respiratory,cardiovascular and autonomic functions, as well as the personal experience of the author in more than 350 cases will be presented and discussed.