Upper thoracic sympathetic surgery

Abstract

Four open surgical approaches have been used to perform upper thoracic sympathectomy. The posterior approach requires access through the posterior muscles of the back, and rib transection. It is a painful operation that has been practically abandoned in favor of the other techniques. The anterior transthoracic approach consists of a formal thoracotomy and never gained popularity. The supraclavicular approach involves dissection of several important anatomical structures. It requires excellent surgical dexterity, but ensures the easiest postoperative recovery. The last approach involves a small transaxillary thoracotomy. Technically, it is the easier procedure. Both the supraclavicular and the transaxillary approaches were widely used until the advent of thoracoscopic surgery. The results (rate of success, recurrences, and sequelae) were similar for all techniques, depending on the procedure performed on the sympathetic chain, not on the access route. Open approaches for upper dorsal sympathectomy are not used any more except in the very rare cases in which thoracoscopy is unfeasible.

Stellate ganglion ischemia on the prevention of pulmonary vasospasm during bilateral carotid artery ligation: The first experimental study

“…Bilateral STG block reduces pulmonary capillary wedge pressure . Cervicothoracic sympathectomy produces a vasodilatory effect that decreases pulse rate and systolic blood pressure …”

“…25 Cervicothoracic sympathectomy produces a vasodilatory effect that decreases pulse rate and systolic blood pressure. 26 Because STG is a major catecholamine-depositing node, 27 its ischemia causes increased catecholamine release related to early complications, but progressive ischemia of STG reduces catecholamine release in the late phase after BCCAL.…”

Single incision thoracoscopic sympathectomy for palmar and axillary hyperhidrosis

“…Before the introduction of video-assisted thoracoscopic surgery (VATS) and the advances in video-endoscopic technology, thoracotomy was the standard surgical approach for hyperhidrosis, which was considered relatively as serious surgery for a relatively simple procedure. 7 Since the 1990s, endoscopic thoracic sympathectomy has become a wellestablished surgical treatment for hyperhidrosis with relatively low morbidity and mortality. 5 In the absence of specific and effective medical treatment for primary hyperhidrosis, thoracoscopic sympathectomy was widely accepted as treatment option by different authors working in the field.…”

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“…The position of the patient, multiple insicion, resection of the T2, T3 and T4 ganglions and insertion of the chest tube were the discussion points of the treatment of primary hyperhidrosis before 20 years. At that time, the effectiveness and complication rate of treatment were compared according to the supraclavicular, posterior, anterior and axillar approach [3]. Currently, the treatment of primary hyperhidrosis is achieved with one port microthoracoscopic sympathectomy and the patient was discharged at the same day [4].…”