Single-port thoracoscopic sympathicotomy for treatment of complex regional pain syndrome type I, a feasibility study.

CRPS type-1 is a pain syndrome that usually develops after an initiating
noxious event (e.g. fracture) in an extremity. Although treatment options life
dimethyl-sulphoxide (DMSO), N-acetylcysteine (NAC) and intensive physical
therapy exist, the treatment effect is often unsatisfactory, even leading to
amputation of the extremity. Surgical treatment of chronic pain disorders by
dividing the sympathetic chain is an established treatment. Its more invasive
nature has prevented widespread application. After introduction of minimal
invasive techniques in recent years, the UMCG has now devised a truly minimal
invasive, yet safe and effective thoracoscopic technique, that requires only a
single 1 cm long incision in the anterior axillary line. This technique is
developed as treatment for primary focal axillary and palmar hyperhidrosis, and
is performed in over 50 patients producing very satisfying results. This fact
has led to the hypothesis that this same surgical technique can offer this
group of chronic pain patients a safe, effective treatment modality.

The effect of the intervention on pain an regain of function in de affected
extremity. This will be quantified in multiple questionnaires at baseline and
three follow-up points, and by clinical evaulation of the hand function at
baseline and two follow-up points.

Single center prospective feasibility study

Unilateral single-port VATS sympathicotomy on T2-T5 level.

Participants will have to fill-out 2 questionnaires at baseline and at three
different points of follow- up. They will undergo pre-operative clinical
examination at the hand clinic of the rehabilitation center, routine blood and
urine testing, ECG, and pre- and postoperative chest X-ray examination. At 1
and 6 months follow-up several parameters measuring hand function will be
evaluated in a clinical setting. Risks associated with the intervention include
chylothorax and pneumothorax requiring prolonged drainage (<1%), bleeding, and
surgical wound infection (<1%). Compensatory hyperhidrosis (excessive sweating)
and referred pain have been described (<6%) after such procedures performed as
treatment for primary hyperhidrosis. It is not known if this side-effects is
seen when the operation is performed for the indication CRPS-I.