5 Questions About Single-Port Thoracoscopic Sympathicotomy in Raynaud Phenomenon

In a recent study, Anniek Maaike van Roon, MD, PhD, from the Department of Internal Medicine, Division of Vascular Medicine, at University Medical Center Groningen, Netherlands, and colleagues assessed the efficacy and feasibility of single-port thoracoscopic sympathicotomy among patients with treatment-resistant Raynaud phenomenon (RP).¹

Findings of the study indicated a unilateral improvement in perfusion in the left hand compared with the right hand after surgery, with cooling and recovery and with laser speckle contrast analysis. 

Rheumatology Consultant caught up with Dr van Roon about the research.

RHEUM CON: What prompted you to conduct the study?

Anniek van Roon: The study was an initiative of the cardiothoracic surgeon, Dr Michiel Kuijpers. With his colleagues, he developed a technique that allows for a single-port access sympathicotomy (the single-port thoracic sympathicotomy, SPTS), instead of the conventional multiport sympathectomy. This was initially developed for patients with severe palmar or axillary hyperhidrosis, but because the procedure proved safe and highly effective, he wondered if it would also be feasible and effective in patients with RP.

RHEUM CON: What is the need for more treatment options for patients with treatment-resistant RP?

AVR: Patients with RP who do not respond to lifestyle interventions, do not benefit from any medicinal vasodilatory treatment, or have severe adverse effects have no treatment options for RP. Some patients, with then-called treatment-resistant RP, experience complications in their daily lives. We know from previous studies that RP can reduce quality of life and can be very limiting for patients.

RHEUM CON: What are the most important findings from your study?

AVR: We found that after one month, not only subjectively but also objectively, SPTS is an effective treatment for RP. With a cooling procedure, during which perfusion of the fingertips is measured, we found a significant increase of perfusion in the left (intervention) hand, compared to the right (control) hand, which is the most important finding. The most important for the patients was that they were all very satisfied with the results and noticed clear differences between their left and right hands. All patients chose to undergo right-sided SPTS as well, after the last study visit at one year.

RHEUM CON: What are the clinical implications of your study?

AVR: In our center, after careful selection of patients with treatment-resistant RP, we now can offer these patients an effective treatment option again. There are no other minimally invasive techniques potentially useful for this patient population. In the past, the conventional sympathectomy was performed in patients with RP; however, they found that the benefit was not worth the risk. With the new techniques, we can reconsider this option.

RHEUM CON: What are the next steps of your research?

AVR: We are following the patients of the study closely, to see what the long-term effects are. Complementary to the 8 patients of the study, we also will follow-up with patients who are undergoing the procedure in our center, to study long-term effects in those patients as well.

Reference:

1. van Roon AM, Kuijpers M, van de Zande SC, et al. Treatment of resistant Raynaud’s phenomenon with single-port thoracoscopic sympathicotomy: a novel minimally invasive endoscopic technique [published online September 16, 2019]. Rheumatology. doi:10.1093/rheumatology/kez386.