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Eur J Cardiothorac Surg 2001;19:546
© 2001 Elsevier Science NL

Letter to the Editor

Reply to Kao

^a Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China
^b Section of Thoracic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan

Received 14 February 2001; accepted 16 February 2001.

Corresponding author. Tel.:+852-2632-2629; fax: +852-2637-7974
e-mail: yimap{at}cuhk.edu.hk

We would like to thank Dr. Kao for his comments on our paper and acknowledge his large experience with this procedure. Dr. E. Kux from Austria first introduced the thoracoscopic approach (before the advent of videoendoscopy) to thoracodorsal sympathectomy in the early 1950’s and reported this in 1951 [1] (The papers published in the 1970’s were by Dr. M. Kux). Video-assisted thoracic surgery (VATS) came to the scene in the early 1990’s and its application for sympathectomy was presented in the First International Symposium on Thoracoscopic Surgery in San Antonio in 1993 by Dr. Harold Urschel and subsequently published in the Annals of Thoracic Surgery [2].

The usefulness of monitoring palmar temperature as a guide to the completeness of sympathectomy is questionable. If the baseline preoperative palmar temperature is already above 33°C, it generally would not go up much further after sympathectomy. Over-reliance on skin temperature in these situations would only bring confusion. We would agree with Dr. Kao that compensatory hyperhidrosis is more likely to occur in patients from whom a long segment of the thoracodorsal sympathetic chain has been resected or ablated. Electocautery ablation has been shown to be as effective as resection [3]. As compensatory hyperhidrosis could be very troublesome and difficult to treat, some centers in Taiwan are now using clips to interrupt nerve conduction rather than relying on resection or electrocautery ablation, in hope that the former could be reversed if need be.

There are many ways to skin a cat. Dr. Kao's technique appears to work well for his patients, as our methods for ours. In the absence of a prospective, randomized study, it would be difficult to say which approach is superior. However, we have been greatly impressed by the cosmetic results (generally no scar could be detected after 1 month) and the little postoperative discomfort experienced by our patients treated using the 2 mm instruments, which have now become our approach of choice.

References

1. Kux E. The endoscopic approach to the vegetative nervous system and its therapeutic possibilities. Dis Chest 1951;20:139-147.
2. Urschel H.C. Dorsal sympathectomy and management of thoracic outlet syndrome with VATS. Ann Thorac Surg 1993;56:717-720.[Abstract]
3. Yim A.P.C. Invited commentary to Zacherl J. et al. Video assistance reduces complication rate of thoracoscopic sympathicotomy for hyperhidrosis. Ann Thorac Surg 1999;68:1181.[Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Anthony P.C. Yim Hui-Ping Liu Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yim, A. P.C. Articles by Liu, H.-P. Search for Related Content PubMed Articles by Yim, A. P.C. Articles by Liu, H.-P.