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Microinvasive transaxillary thoracoscopic sympathectomy: technical note
J B Wahlig1, W C Welch, T L Weigel
1Department of Neurological Surgery, University of Pittsburgh, Presbyterian University Hospital, Pennsylvania 15213, USA.
Objective:
To describe a two-port transaxillary thoracoscopic approach for thoracic sympathectomy that maximizes working space, improves manipulative ability, and enhances visualization of the surgical field.
Methods:
Positioning of the patients was optimized to displace the scapula posteriorly, widen the avenue of approach to the sympathetic ganglia, and create a more direct route to the target. The semi-Fowler position permitted the lung apex to fall away from mediastinal structures, obviating a separate retraction port. A 30-degree endoscope allowed an unobstructed view of surgical progress, and anatomic relationships were manipulated in a temporal sequence to facilitate dissection.
Results:
Microinvasive transaxillary sympathectomy was performed successfully in 13 patients, all of whom had a good outcome without complications.
Conclusion:
The modifications implemented increase the speed and safety of thoracoscopic sympathectomy while minimizing complications.