T3 Endoscopic Thoracic Ganglionectomy Using Cutting Mode Cautery for Palmar Hyperhidrosis

Area of Science:

• Anatomy
• Surgical Procedures
• Hyperhidrosis Treatment

Background:

• Accurate upper thoracic sympathetic trunk anatomy is vital for successful endoscopic thoracic sympathectomy (ETS) in palmar hyperhidrosis.
• Variability in T2 and T3 ganglia location relative to ribs impacts ETS clinical outcomes.

Purpose of the Study:

• To investigate the anatomical relationship of T2 and T3 ganglia to ribs.
• To evaluate the efficacy of T3 ganglionectomy for palmar hyperhidrosis.
• To identify strategies for improving ETS accuracy.

Main Methods:

• Cadaveric dissection to map T2 and T3 ganglia locations via white rami communicantes.
• Thoracoscopic T3 ganglionectomy performed on pediatric patients.
• Assessment of surgical outcomes and compensatory sweating post-ETS.

Main Results:

• 74 pediatric patients underwent T3 ganglionectomy with high satisfaction and no compensatory sweating.
• Cadaver dissections revealed T2 ganglia near the third rib and T3 ganglia near the fourth rib.
• A significant percentage of T2 ganglia are located near the superior border of the third rib.

Conclusions:

• ETS targeting the third rib risks accidental T2 ganglion thermal injury.
• Utilizing the white ramus communicans as a guide enables precise T3 ganglion-oriented ETS.
• Ganglion-oriented T3 ETS enhances surgical accuracy and patient outcomes for palmar hyperhidrosis.