P58 SINGLE-PORT THORACOSCOPIC SYMPATHICOTOMY FOR TREATMENT RESISTANT RAYNAUD’S PHENOMENON: FIRST REPORT OF A NOVEL MINIMALLY INVASIVE ENDOSCOPIC TECHNIQUE

Abstract

Background: Raynaud’s phenomenon of the hands is a great burden and reduces quality of life. In some patients, complaints may be resistant to vasodilatory treatment, for which additional options are very limited. Previously thoracic sympathectomy has been shown effective, but with great surgical burden. In our centre, single-port thoracoscopic sympathicotomy (SPTS) was developed, a new minimally invasive endoscopic technique extensively limiting surgical burden. Objectives: The aim of this pilot study was to evaluate feasibility and efficacy of SPTS in patients with treatment resistant Raynaud’s. Methods: In the current study, we aim to include 10 patients with treatment resistant Raynaud’s. SPTS was performed on the left side and the effects were compared contralateral after 1 and 12 months. To assess perfusion of the hands a cooling fingertip plethysmography (PPG) and laser Doppler imaging (LDI) were used. Pulse wave velocity (PWV) of the carotis-femoralis and carotis-radialis was measured. Results: During this interim report, 7 patients are included so far (age 42 ± 13 years, 5/2 male/female, 5/2 primary/secondary Raynaud’s). All 7 patients were satisfied. A clear improvement in hand perfusion was observed with LDI and PPG during cooling, as compared to the contralateral side. A trend in decrease of PWV carotis-radialis left was seen, while PWV at the other sites did not change significantly (figure 1). Conclusions: SPTS is a novel minimally invasive technique which appears to be safe and feasible in patients with treatment resistant Raynaud’s and increases hand perfusion. However, this study is on-going and long-term efficacy needs to be established.