الفهرس 
HISTORICAL REVIEWOnly 14 pages are availabe for public view
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Abstract
S
cientists became fascinated with the idea of sympathectomy in the mid-19th century. It was used to treat many conditions as epilepsy, glaucoma, goitre and hypertension. Nowadays sympathectomy is described for the treatment of a wide variety of disorders, for relief of palmar hyperhidrosis, reflex sympathetic dystrophy (RSD), causalgia, upper extremity ischemia (Raynaud’s disease) and LQTS among other indications (Rafael, 2006).
Recent advances in endoscopic technology have led to the almost universal adoption of the endoscopic transthoracic route as the preferred technique for upper limb sympathectomy. Thoracoscopic sympathectomy is a safe and effective method of managing these patients, fewer incisions, less external and internal tissue trauma comparing with open appraoches. With ETS bilateral thoracoscopic sympathectomy can be performed easily which is safe and effective, with excellent results when used for appropriate indications (Berman et al., 2004).
The traditional therapeutic options for the management of palmar hyperhidrosis include topical antiperspirants, anti-cholinergic drugs, iontophoresis and more recently botulinum toxin injections. These methods give sufficient relief and transient effects. ETS nowadays is considered as the treatment of choice for moderate to severe hyperhidrosis (Georgios et al., 2004).
The efficacy of sympathectomy in the management of peripheral ischemia is not a new concept, many reports in the literature confirm the efficacy of sympathectomy for treating gangrene and ulcers due to occlusive arteriosclerosis of upper limb arteries (Giacomo et al., 2002).
Previously, sympathetically mediated pain syndromes required highly invasive surgical procedures to resect a relatively small portion of the upper thoracic sympathetic ganglia. In the treatment of sympathetically mediated disorders, thoracoscopic sympathectomy as a minimally invasive technique has equivalent outcomes to those reported in previous open surgical techniques, the associated morbidity rate and the hospital stay are substantially reduced (Kargar and Parizi, 2001).
ETS is a safe as well as an effective technique for the treatment of congenital long QT syndromes. This procedure produces an adequate cardiac sympathetic denervation, correction of long QT and improvement of clinical symptoms (Wang, 2003).
Although ETS is a simple quick procedure it has its complications, the most common one is compensatory hyperhidrosis which improve with time, Postoperative Horner’s syndrome is rare and is caused by direct or indirect damage to T1. VATS approach reduces the rate of HS because of both better visualization and better identification of the anatomy and by gentle handling of the sympathetic chain. Also serious complications have been reported such as subclavian artery injury, damage to brachial plexus, large hemothorax, sinus bradycardia and cardiac arrest which can lead to death (Santa et al., 2003).
Endoscopic transthoracic sympathectomy invasive procedure which utilizes a telescope and video technology in the thoracic cage. It is very effective in treatment of many conditions reducing the postoperative morbidity and hospital stay, also it avoids the morbid incision and many complications of open sympathectomy.