Abstract
Background The clipping of the thoracic sympathetic nerve, which has been a technique used for
approximately the past 10 years, has rapidly become popular because of its “bring-back”
claim. However, the information regarding the mechanism behind this claim is based
on investigator’s comments and has not been proven by objective research, such as
the histopathological examination of the clipped nerve and/or ganglion. We aimed to
evaluate sympathetic regeneration and degeneration after clip removal.
Methods The rabbits were divided into two groups with six rabbits per group. For the first
group (group A), the sympathetic chain was clipped using two titanium clips, and a
right thoracotomy was made at the T4 and T5 levels. For the second group (group B),
the animals were also operated on, which was similar to the rabbits in group A. At
the end of a 48-hour follow-up period, the clips were removed after a second operation.
The rabbits in group B were followed for 45 days and sympathetic nerves were also
examined histopathologically.
Results In group A, hemorrhage, fibrinous material, polymorphonuclear leukocyte infiltration,
and acute inflammation with fat necrosis were observed in and around the sympathetic
ganglia and trunk. Loss of nuclei and vacuolization in some sympathetic ganglia cells
were also observed. These findings demonstrated severe degeneration of the sympathetic
ganglia and trunk. For group B, microscopic examination revealed a loss of sympathetic
ganglion cells as well as fibrosis within and around the ganglia. No signs of regeneration
were detected and the progression of nerve degeneration was observed.
Conclusions The clips used in our study were shown to cause the degeneration of neural structures
within 2 days. At the end of the 45 days following the removal of the clips, progressive,
degenerative changes radiating along the axons of the sympathetic cells were seen.
Keywords
hyperhidrosis - thoracoscopy/VATS - surgery - complications
