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Upper thoracic sympathetic surgery. Open surgical techniques
1Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Summary
Four open surgical approaches for upper thoracic sympathectomy were historically used. Success rates were similar across methods, with thoracoscopic surgery now being the preferred technique.
Area of Science:
- Thoracic Surgery
- Surgical Techniques
Background:
- Upper thoracic sympathectomy has historically utilized four open surgical approaches.
- These include posterior, anterior transthoracic, supraclavicular, and transaxillary techniques.
Purpose of the Study:
- To review and compare the historical open surgical approaches for upper thoracic sympathectomy.
- To discuss the evolution of surgical techniques in this field.
Main Methods:
- Review of historical surgical approaches for upper thoracic sympathectomy.
- Comparison of outcomes and technical considerations for each open approach.
Main Results:
- Posterior and anterior transthoracic approaches are largely abandoned due to pain and low popularity, respectively.
- Supraclavicular and transaxillary approaches were common but superseded by thoracoscopic surgery.
- Success rates, recurrences, and sequelae were comparable across open techniques, dependent on the sympathectomy procedure itself, not the surgical access route.
Conclusions:
- Open surgical approaches for upper dorsal sympathectomy are now rarely used, primarily reserved for cases where thoracoscopy is not feasible.
- The choice of surgical technique for sympathectomy, rather than the access route, dictates patient outcomes.