Hi kingflab,

I would urge you to cast a skeptical eye on the findings of this research. Like most of what passes for scientific research on the effects of this surgery, it is methodologically flawed to the point that any conclusions drawn from the findings are suspect. If you do exhaustive research, you'll find numerous similar studies that contradict the findings of the ones you have cited. I've read several studies where the findings indicate even lower rates of severe side effects for T2 surgery. For example, back in the mid-nineties, many surgeons published findings they claimed showed that severe side effects arise from cutting more than one ganglion and demonstrated (using methodologies identical to the studies you cited) that operating on T2 alone was the best way to reduce side effects.

These studies are subjective, short term, uncontrolled and non-randomized. No quantitative data are collected. No standardized, objective criteria are used to diagnose the pre-existing condition or to measure the severity of the side effects. Given these flaws of methodology, one cannot conclusively show a causal relationship between the location of the surgery and the frequency and severity of the side effects. Proper scientific research would require quantitatively measuring important metrics (like degree of perspiration on various regions of the body under controlled conditions) prior to surgery and after the surgery for several years.

And, not only are studies fatally flawed from a scientific standpoint, the researchers are anything but disinterested parties. In fact, these studies are almost always conducted by individuals with a direct financial conflict of interest in the results of the research. Scientists working for the tobacco companies have published research showing that smoking has no ill effects on human health. Nobody believes that research because of its source. I know most people like to believe doctors are above allowing their personal financial conflict of interest to bias their research, but, frankly, I think that is naive.

In short, while it may be true that sympathetic denervation surgery targeted at T4/T5 leads to fewer side effects, the cited research fails to prove that notion conclusively. I would urge you to dig deeply in your research and try and resist the desire to focus solely on findings that say what you would like to hear, i.e. that the surgeons have found a way to substantially reduce the probability of severe side effects. If you dig back several decades, you'll find that every few years the surgeons publish findings that claim a particular technique or location of surgery dramatically reduces side effects. But, their track record is dismal.

Good luck.