[Surgical technique of endoscopic transthoracic sympathicotomy: axillary approach]

A total of 181 endoscopic transthoracic sympathicotomy were performed at our hospital from December, 1992 to March, 1997. After single-lumen endotracheal intubation for general anesthesia, the patient was placed in half sitting position. A small (1 cm) incision was made in the anterior axillary line through the third intercostal space and an apical pneumothorax was created by insufflation of 1.8 L of CO2 in the pleural cavity through a Surgineedle. A 24 Fr. urological transurethral electroresectoscope was introduced through the same incision. The sympathetic chain could be observed through parietal pleura riding on the costovertebral junctions. In palmar hyperhidrosis the second and third thoracic sympathetic ganglia were electrocoagulated. In axillary hyperhidrosis the forth ganglion was included. The lung was expanded by limiting expiration and sucking CO2. The operation was repeated on the other side. Endoscopic transthoracic sympathicotomy was an efficient, safe and low invasive surgical procedure for the treatment of palmar, axillary hyperhidrosis, Raynaud's disease and Buerger disease.