Weisheng Chen, MD, Wen Wang, MD, Shengsheng Yang, MD, Dazhou Li, MD, Long Chen, MD, Zhijian Zhang, MD, Kelong Lin, MD, Lihuang Zhu, MD, Xuegang Feng, MD, Duohuang Lian. Fuzhou General Hospital
INTRODUCTION: Thoracoscopic sympathectomy is an effective treatment for palmar hyperhidrosis. Currently, sympathectomy is performed through a transthoracic approach, which is associated with risks of chronic neuropathic pain and visible chest scar. We developed a novel surgical technique for performance of sympathectomy by Natural Orifices Trans Umbilical Surgery (NOTUS) without thoracotomy in a swine model.
METHODS: Under general anesthesia, animals were intubated and mechanically ventilated with a dual lumen endotracheal tube through tracheostomy. A newly developed long transabdominal trocar (80cm in lengths) with deflectable distal end was placed through the umbilicus. After insertion of gastroscope through this trocar, two small incisions of both diagrams were created by needle-knife. The gastroscope together with trocar was introduced into the thoracic cavity. The sympathetic chain was identified at the desired thoracic level and ablated. The sympathectomy was repeated over the other side. The animals were euthanasia after the procedure and postmortem examination was performed. RESULTS: This procedure was completed in four pigs. The mean weight of the pig was 43.4 ± 1.4Kg and the mean operative time was 87.7 ± 16.2 minutes. There was no major bleeding. All bilateral T3 sympathetic chains were successfully ablated in the 4 swine as confirmed by gross surgical pathology and histology. Only the first case needed fluoroscopic guidance for the identification of T3. CONCLUSIONS: Endoscopic sympathectomy through Natural Orifices Trans Umbilical Surgery is technically feasible, simple and safe in a porcine model. This novel procedure obviates the necessity of thoractomy and visible chest scars, and eliminated the possibility of chronic chest wound pain associated with traditional thoracoscopic sympathectomy
Fig 1 A newly developed long transabdominal trocar with deflectable distal end
Fig 2 The insertion of gastroscope with trocar through the umbilicus
Fig 3 The sympathetic chain was ablated
Program Number: P209