Feasibility of endoscopic transesophageal thoracic sympathectomy (with video)
Received 20 February 2009; accepted 9 July 2009. published online 02 November 2009.
Background
Thoracoscopic sympathectomy is the preferred surgical treatment for patients with disabling palmar hyperhidrosis. Current methods require a transthoracic approach to permit ablation of the thoracic sympathetic chain.
Objective
To develop a minimally invasive, transesophageal endoscopic technique for a sympathectomy in a swine model.
Design
Nonsurvival animal study.
Setting
Animal trial at a tertiary care academic center.
Subjects
This study involved 8 healthy Yorkshire swine.
Interventions
After insertion of a double-channel gastroscope, a Duette Band mucosectomy device was used to create a small esophageal mucosal defect. A short, 5-cm submucosal tunnel was created by using the tip of the endoscope and biopsy forceps. Within the submucosal space, a needle-knife was used to incise the muscular esophageal wall and permit entry into the mediastinum and chest. The sympathetic chain was identified at the desired thoracic level and was ablated or transected. The animals were killed at the completion of the procedure.
Main Outcome Measurements
Feasibility of endoscopic transesophageal thoracic sympathectomy.
Results
The sympathetic chain was successfully ablated in 7 of 8 swine, as confirmed by gross surgical pathology and histology. In 1 swine, muscle fibers were inadvertently transected. On average, the procedure took 61.4±24.5minutes to gain access to the chest, whereas the sympathectomy was performed in less than 3minutes in all cases. One animal was killed immediately after sympathectomy, before the completion of the observation period, because of hemodynamic instability.
Limitations
Nonsurvival series, animal study.
Conclusions
Endoscopic transesophageal thoracic sympathectomy is technically feasible, simple, and can be performed in a porcine model.
Current affiliations: Gastrointestinal Unit (B.G.T., S.C., C.K., F.W., W.R.B.), Department of Surgery (D.W.G., Y.K., C.M., D.W.R.), Department of Pathology (M.M.-K.), Massachusetts General Hospital, Boston, Massachusetts, USA
Reprint requests: William R. Brugge, MD, FASGE, Gastroenterology Unit, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.
DISCLOSURE: This project was fundedby the Center for Integration of Medicine and Innovative Technology. Dr Brugge disclosed a consultant relationship with Boston Scientific. All other authors disclosed no other financial relationships relevant to this publication.
The video from this article was presented at the 4th International NOSCAR Conference on NOTES, July [9-11], 2009, Boston, MA.
ABSTRACT
Feasibility of endoscopic transesophageal thoracic sympathectomy (with video)