What is thoracoscopic sympathectomy?

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Thoracoscopic sympathectomy: Overview

Thoracoscopic sympathectomy is surgery to cut or clamp the sympathetic nerves. These nerves run down both sides of the spine. The surgery may be done to help control heavy sweating of the hands. It also may be used to treat chronic pain or other problems with the sympathetic nerve system. This surgery may also be called endoscopic thoracic sympathectomy.

You may be asleep during this surgery. Or you may get medicine to prevent pain and make you relax during surgery. The doctor may make a small cut (incision) in a space between your ribs near your armpit. The doctor will put a thin, lighted tube with a camera on it into your chest through the incision. This tube is called a scope. It lets your doctor see inside your chest. Then the doctor will guide small surgical tools through the incision. The doctor will use these tools to cut or clamp the nerves. The procedure can then be done on the other side of the chest.

The incisions may be closed with stitches. You will have small scars that will fade with time.

You may go home the same day as the surgery. Or you may stay 1 night in the hospital.

How can you care for yourself after a thoracoscopic sympathectomy?

Activity

  • Rest when you feel tired. Getting enough sleep will help you recover.
  • Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
  • Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, for 3 to 4 weeks or until your doctor says it is okay.
  • For 3 to 4 weeks, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, or cat litter or dog food bags.
  • Do breathing exercises at home as instructed by your doctor.
  • Ask your doctor when you can drive again.
  • You may need to take 1 to 3 weeks off from work. It depends on the type of work you do and how you feel.

Diet

  • You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
  • If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
  • Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
  • Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If you think your pain medicine is making you sick to your stomach:
    • Take your medicine after meals (unless your doctor has told you not to).
    • Ask your doctor for a different pain medicine.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

  • If you have strips of tape on the incisions, leave the tape on for a week or until it falls off.
  • Wash the area daily with warm, soapy water and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
  • You may shower 1 to 2 days after surgery, if your doctor says it is okay. Pat the incisions dry. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay.
  • Do not use any creams, lotions, powders, ointments, or oils unless your doctor tells you it is okay.

How do you prepare for a thoracoscopic sympathectomy?

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

  • Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
  • Understand exactly what surgery is planned, along with the risks, benefits, and other options.
  • If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
  • Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
  • Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

After thoracoscopic sympathectomy: When to call

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have severe trouble breathing.
  • You have severe chest pain.
  • You have sudden chest pain and shortness of breath, or you cough up blood.

Call your doctor now or seek immediate medical care if:

  • You have pain that does not get better after you take pain medicine.
  • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the incision.
    • Pus draining from the incision.
    • A fever.
  • You have loose stitches, or your incisions come open.
  • You are bleeding a lot from the incisions.
  • Your heartbeat feels very fast, skips beats, or flutters.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

After a thoracoscopic sympathectomy: Overview

Thoracoscopic sympathectomy is surgery to cut or clamp the sympathetic nerves. These nerves run down both sides of the spine. The surgery may be done to help control heavy sweating of the hands. It also may be used to treat chronic pain or other problems with the sympathetic nerve system.

Your chest may be sore where the doctor made the cuts (incisions) and put the surgical tools. This usually gets better after several days. But for up to 2 weeks, you may feel pain in your chest when you take a deep breath. Avoid strenuous activity and lifting anything heavy for about 3 to 4 weeks or until your doctor says it is okay.

After this surgery, some people notice that they feel dizzy if they stand up too quickly. This usually gets better with time.

What happens on the day of your thoracoscopic sympathectomy?

  • Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
  • Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
  • Do not shave the surgical site yourself.
  • Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

  • Bring a picture ID.
  • The area for surgery is often marked to make sure there are no errors.
  • You will be kept comfortable and safe by your anesthesia provider. You may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb. Or you may be asleep during the surgery.
  • The surgery will take about 1 to 2 hours.

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