A recent survey conducted among members of the European Society of Thoracic Surgeons (ESTS) sheds light on current practices in thoracic sympathetic surgery. The questionnaire, distributed between December 2022 and February 2023, explored various aspects such as patient demographics, surgical indications, preoperative assessments, techniques employed, complications encountered, and follow-up procedures. Although only a small percentage of ESTS members participated, their responses provide valuable insights into the diverse approaches adopted across Europe.

Among the respondents, the vast majority perform sympathetic surgery for hyperhidrosis or facial flushing conditions, while fewer surgeons apply it for cardiac and vascular diseases. Palmar hyperhidrosis stands out as the most prevalent condition requiring intervention, followed by axillary hyperhidrosis, facial flushing, and craniofacial hyperhidrosis. Furthermore, when treating cardiac conditions like catecholaminergic ventricular tachycardia, long QT syndrome, Raynaud’s disease, and Buerger’s disease, surgeons tend to favor nerve cutting over clipping due to its perceived effectiveness. However, opinions vary regarding the optimal level of nerve block depending on the specific ailment being addressed, highlighting the need for more standardized protocols.

Despite some consensus among surgeons about certain practices, significant variability exists in almost every aspect of thoracic sympathetic surgery. This heterogeneity underscores the importance of establishing a comprehensive database that can assist in standardizing patient selection criteria, surgical methodologies, and post-operative care. Such a resource would not only enhance treatment outcomes but also pave the way for future multi-institutional trials aimed at advancing the field further. By fostering collaboration and sharing knowledge, the medical community can continue striving toward improved patient care and innovative solutions in thoracic autonomic nervous system surgery.