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The survey shows different practices in thoracic sympathetic surgery across Europe
Background: Thoracic autonomic nervous system surgery is mainly used for hyperhidrosis/facial lavage, while cardiac and vascular indications are limited. The literature remains controversial regarding the correct indications and surgical technique, with the lack of homogeneous data being a major limitation. We developed a survey to examine current practice among members of the European Society of Thoracic Surgeons (ESTs). Methods: A 29-question ad hoc questionnaire was available to all ESTS members from December 2022 to February 2023. It included questions regarding demographics, indications, preoperative evaluation, technique, complications, and follow-up. A descriptive analysis of the data is presented. Results: The response rate was...
The survey shows different practices in thoracic sympathetic surgery across Europe
Background:Thoracic autonomic nervous system surgery is mainly used for hyperhidrosis/facial lavage, while cardiac and vascular indications are limited. The literature remains controversial regarding the correct indications and surgical technique, with the lack of homogeneous data being a major limitation. We developed a survey to examine current practice among members of the European Society of Thoracic Surgeons (ESTs).
Methods:From December 2022 to February 2023, a 29-question ad hoc questionnaire was available to all ESTS members. It included questions regarding demographics, indications, preoperative evaluation, technique, complications, and follow-up. A descriptive analysis of the data is presented.
Results:The response rate was 7% and 121 of 123 valid responses were analyzed. Sympathetic surgery was performed for hyperhidrosis/facial lavage, cardiac and vascular diseases in 99%, 29% and 29% of respondents, respectively. Palmar hyperhidrosis was the most common, followed by axillary, facial and craniofacial hyperhidrosis. Catecholaminergic ventricular tachycardia was more common than long QT syndrome and Raynaud's disease of Buerger. Data analysis showed that members preferred nerve cutting over clipping (66%, 64% and 58% for hyperhidrosis/facial irrigation, cardiac and vascular disease). The preference for the target level of nerve block varied significantly depending on the condition addressed. In most responders (65%), severe compensatory sweating was an adverse event, occurring in less than 10% of treated cases. Only 52% used a database for follow-up.
Conclusions:Current practice in sympathetic surgery in ESTS responders is consistent with the available evidence, although characterized by great heterogeneity in almost all aspects. A database could help standardize patient selection, surgical techniques and follow-up and provide the basis for future multi-institutional studies.
Key Findings
• This survey described the habits of a small group of respondents among members of the European Society of Thoracic Surgeons when treating thoracic nervous system surgery.
• The response rate was 7%.
• Sympathetic surgery was adopted for hyperhidrosis/facial flushing, cardiac and vascular diseases by 99%, 29% and 29% of responders. Palmar was the most common hyperhidrosis disorder, followed by axillary, facial flushing and craniofacial hyperhidrosis.
• Members prefer nerves that are exaggerated.
• Nerve block target level preference varied significantly based on each condition addressed.
What is known and what is new?
• Despite many publications in the literature, there are no guidelines for surgical thoracic autonomic nervous system surgery.
• Despite good agreement with the only consensus statement in the world literature, there was heterogeneity of responses in each section of the questionnaire in this study.
What is the implication and what should change now?
• Our results suggest the need for a common database that could help standardize patient selection, surgical techniques, and follow-up and provide the basis for future multi-institutional studies.
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