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Key Points

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  1. For thoracoscopic sympathectomy for primary hyperhidrosis and thoracoscopic spine exposure for release of thoracic scoliosis, video-assisted thoracoscopic surgery (VATS) offers several advantages, including shorter hospital stay for patients and lower morbidity.

  2. Surgical treatment is recommended for severe cases of primary hyperhidrosis or those refractory to medical management. Upper thoracic sympathectomy interrupts transmission of impulses from the sympathetic ganglia to the sweat glands and can offer immediate and permanent relief.

  3. Compensatory sweating (CS) occurring in the back, chest, and thighs is the most common side effect of thoracoscopic sympathectomy, but the reported incidence and severity are lower than in adults and very few adolescent patients express regret for having undergone thoracoscopic sympathectomy.

  4. The initial access for thoracoscopic spine exposure should be just above the level of the central-most portion of the proposed release.

  5. At each level, the intervertebral space is entered by using electrocautery to incise the pleura and overlying fascia between the segmental vessels superior and inferior to the line of incision and standard curets and other extraction devices are used to remove the disk.

  6. When all the selected disks have been removed, the bone graft that has been harvested from the iliac crest and morcellated can be packed into each intervertebral space.

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Introduction

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The use of thoracoscopic methods to perform surgical procedures in infants and children has burgeoned over the several years. Familiarity with approaches and instrumentation along with the more widespread use of these techniques has led to the routine use of thoracoscopy in some institutions. This chapter focuses on 2 growing applications for a minimally invasive thoracic approach in the pediatric population: thoracoscopic sympathectomy for primary hyperhidrosis and thoracoscopic spine exposure for release of thoracic scoliosis.

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Thoracoscopic Sympathectomy for Palmar Hyperhidrosis

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Indications

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Hyperhidrosis is a condition of excessive perspiration beyond physiological needs. Primary palmar hyperhidrosis (PHH) is part of a triad of excessive sweating of the axillae, feet, and hands. The etiology is unknown but can lead to significant psychological, social, and occupational inconvenience. Conservative management with antiperspirants, iontophoresis, botox injections, and systemic medications such as anticholinergics are temporary, but may be effective for mild forms of hyperhidrosis. Surgical treatment is recommended for severe cases or those refractory to medical management. Upper thoracic sympathectomy interrupts transmission of impulses from the sympathetic ganglia to the sweat glands and can offer immediate and permanent relief. Although rarely performed via an open approach, the video-assisted thoracoscopic technique offers the benefit of high visibility of the surgical field, low morbidity, short hospital stay, and excellent cosmetic results.

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Most hyperhidrosis series involve adult populations who have had longstanding symptoms since childhood and have undergone sympathectomy 10 to 15 years after the onset of symptom onset. Others have reported improved outcomes for children compared to adults with regard to long-term satisfaction as well as decreased severity and incidence of compensatory sweating (CS). These ...

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