Treatment of resistant Raynaud's phenomenon with single-port thoracoscopic sympathicotomy: a novel minimally invasive endoscopic technique

Anniek M van Roon, Michiel Kuijpers, Saskia C van de Zande, Amaal Eman Abdulle, Arie M van Roon, Reinhard Bos, Wobbe Bouma, Theo J Klinkenberg, Hendrika Bootsma, Mike J L DeJongste, Massimo A Mariani, Andries J Smit, Douwe J Mulder, Anniek M van Roon, Michiel Kuijpers, Saskia C van de Zande, Amaal Eman Abdulle, Arie M van Roon, Reinhard Bos, Wobbe Bouma, Theo J Klinkenberg, Hendrika Bootsma, Mike J L DeJongste, Massimo A Mariani, Andries J Smit, Douwe J Mulder

Abstract

Objective: To assess the minimally invasive single-port thoracoscopic sympathicotomy feasibility and efficacy in patients with treatment-resistant RP.

Methods: Single-port thoracoscopic sympathicotomy was performed unilaterally on the left side in eight patients with RP (six males, two females, with a median age of 45.2 years). Five patients had primary and three had secondary RP. Perfusion effects in the hands were assessed at baseline and after 1 month by using a cooling and recovery procedure, and by using laser speckle contrast analysis. Number and duration of RP attacks were reported over a 2-week period.

Results: Patient satisfaction was 100% after surgery. After surgery, a unilateral improvement in perfusion was observed in the left hand compared with the right hand, with cooling and recovery (P = 0.008) and with laser speckle contrast analysis (P = 0.023). In addition, the number and duration of the attacks in the left hand decreased compared with the right hand (both P = 0.028). No serious adverse events occurred in a follow-up period of at least 10 months.

Conclusion: Single-port thoracoscopic sympathicotomy is feasible and can be effective in improving hand perfusion in patients with RP. However, long-term efficacy needs to be established.

Clinical trial registration number: NCT02680509.

Keywords: Raynaud’s phenomenon; blood perfusion; laser speckle contrast analysis; sympathicotomy.

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Figures

Fig . 1
Fig. 1
Single-port thoracoscopic sympathicotomy of the third rib (A, B) Intra-operative view of the sympathetic chain running down the dorsal thoracic wall, lateral of the costo-vertebral junction. In the left upper corner, the subclavian artery can be seen. (C) Detail of the third rib after R3 sympathicotomy. (D) Left and right difference of the hands of a patient during a Raynaud’s attack, 1 month after left-sided R3 sympathicotomy.
Fig . 2
Fig. 2
Cooling and recovery procedure Mean number of fingers per hand with normal perfusion during the cooling and recovery procedure pre-operatively (baseline) and 1 month post-operatively after left-sided single-port thoracoscopic sympathicotomy (SPTS).

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