Microinvasive transaxillary thoracoscopic sympathectomy: technical note.

Abstract

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. 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. Microinvasive transaxillary sympathectomy was performed successfully in 13 patients, all of whom had a good outcome without complications. The modifications implemented increase the speed and safety of thoracoscopic sympathectomy while minimizing complications.