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J Thorac Cardiovasc Surg 2008;135:640-641
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr Mark J. Krasna (Baltimore, Md). This study purports to measure sweat output after thoracoscopic sympathectomy with a technique not previously described. Dr Bonde, I congratulate you on making it here through your visa issues, and I did get a chance to look quickly at the manuscript before the meeting.

The technique described is actually elegant, and the trial of that small a number is to be commended as a good prospective evaluation. The procedure in clinical terms is generally more than 95%, even 98%, successful, so it is not 100% clear to me how this information can be used in clinical practice.

I have a couple of questions. As we know, most reports on thoracoscopic sympathectomy have demonstrated such a high success rate that the only limitation is in fact compensatory sweating. Compensatory sweating in different institutional reports has ranged from as low as 30% to a more typical 60% and even 80%. It seems that in your series even those patients who had compensatory sweating did not have a significant amount of sweat output, which is remarkable. So my first question is, how do you account for such a low incidence and low volume of compensatory sweating?

I think another question needs clarification is the surgical technique involved. In a recent review of thoracoscopic sympathectomy techniques throughout the world, there is a great disparity between what people call a T2 and a T3 sympathectomy. Can you clarify for us exactly where the cuts were made along the sympathetic chain? It is my impression now that I've seen the manuscript that you actually cut over the second rib and over the third rib, which some people would call simply a T2 sympathectomy and not a T2–T3. If you can, please clarify that. Otherwise, I enjoyed your presentation. I think . . . [Full Text of this Article]

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An objective assessment of the sudomotor response after thoracoscopic sympathectomy

Pramod Bonde, Nnamdi Nwaejike, Colin Fullerton, Judith Allen, and James Mcguigan
J. Thorac. Cardiovasc. Surg. 2008 135: 635-641. [Abstract] [Full Text] [PDF]