The influence of the sympathetic nervous system on the control of circulation was described for the first time by Claude Bernard and Brown Sequard in 1852. In 1889, Gaskell and Langley suggested that there is correspondence between the paravertebral sympathetic ganglia and peripheral anatomic regions. In 1889, Jaboulay severed nerve fibers that surround the femoral artery to treat the trophic disturbances of the legs and feet. Leriche, Jaboulay’s disciple, in 1913, extended this procedure to the treatment of pain and trophic syndromes of arterial origin of the arms and legs. This procedure gained popularity after 1914, when Kramer and Todd showed that the fibers that surrounded the vessels were of sympathetic origin.
In 1921, Jonnesco proposed the resection of the stellate ganglion for the treatment of angina pectoris.
In 1927, Kuntz showed the influence of the stellate ganglion on the first, second and third thoracic ganglia and their communicating rami on the activation of the sweat glands and the vasoconstriction of the hands.
Starting in the 1930’s, doctors changed their approach to the cervical-thoracic sympathetic chain, using new procedures that preserved the stellate ganglion, trying to avoid Horner’s Syndrome (miosis, enophthalmia and eyelid ptosis).
Several new points of access to the thoracic sympathetic chain were created, including through the supraclavicular region, the anterior thorax and the axilla, along with variations to the traditional paravertebral access. These methods were in use until recently in many hospitals, despite the surgical access being more traumatic, painful, difficult and morbid than the sympathectomy itself.
Erhard Kux, considered the father of endoscopic surgery of the autonomic nervous system, in 1939, associated endoscopic thoracic sympathectomy (ETS) with pneumothorax treatment for pulmonary tuberculosis, based on the operation previously performed by Jacobeus. His aim was pulmonary vasodilatation and a decrease in the tension on the pulmonary elastic fibers. From the endoscopic access to the neuro-vegetative trunk made possible by Erhard Kux, a vast field of surgical procedures theretofore unknown or poorly explored was opened.
Erhard Kux associated ETS to right thoracic vagotomy and splanchnicectomy for the treatment of peptic ulcer and published hundreds of cases with excellent initial results and 30% relapse after 2 years. He performed endoscopic thoracic sympathectomy for the treatment of chest angina, arterial hypertension, asthma, spontaneous pneumothorax, pulmonary cysts (air or liquid), heart arrhythmia, cardiomyopathy, diabetes, postcholecystectomic syndrome, icterus catarrhalis (infectious jaundice), superior limb peripheral vasopathy, thrombophlebitis, causalgia, phantom pain, arthropathies, sympathetic dystrophy, renal lithiasis, neuropsychiatric pathologies: morphisms, multiple sclerosis, schizophrenia, epilepsy, hyperthyroidism, migraine, hiccups, pancreatitis, breast edema, etc. This experience resulted in a book: Thoracoscopic Interventions on the Nervous System, published in 1954. Most these indications fell out of use, either because of the bad results or because of advances in the pathophysiological knowledge of the infirmity and better clinical treatments.
In 1947, Erhard Kux, in Germany, along with his nephew, Dr. Peter Kux, performed the first thoracic sympathectomy for the treatment of palmprint hyperhidrosis.
At the end of 1947, Dr. Peter Kux moved to Brazil and, in 1949, in the city of Acesita, Minas Gerais, performed the first endoscopic sympathectomy in Brazil for the treatment of palmar hyperhidrosis. In 1954, Dr. Peter Kux moved to Belo Horizonte, where he performed surgery until his death on April 23rd, 2008.
Despite the practicality, safety, low morbidity and mortality of the endoscopic method, it wasn’t very widely disseminated, being restricted to few centers in Germany, Switzerland and Brazil. Our group has performed ETS since 1954 for the treatment of various infirmities, especially hyperhidrosis.
In the 1980’s, the thoracoscopic procedure gained exponents in England, Ireland, Sweden and Taiwan with variations as to the access point of the thorax.
From the 1990’s, with the promulgation of videoendoscopic surgery, videothoracoscopy was established as the preferred procedure for the endoscopic access to the sympathetic trunk.
Dr. Peter Kux (L), DR.Chien-ChihLin* (center) and Dr. João Bosco (D)* Dr. Lin, a surgeon who developed the Clip method, visiting our Clinic.