Thoracic Thoracoscopic Sympathectomy. A. ANATOMY. Sympathetic fibers emanate from T1 to L2 or L3 and travel out on the ventral roots, then via white rami into the sympathetic chain. The T2 and T3 roots contain most of the vasoconstrictor fiber to the upper extremity.
or L3 and travel out on the ventral roots, then via white rami into the sympathetic chain.
4. The sympathetic outflow to the ciliary
muscle and pupillary constrictor of the eye
is from T1.
5. The knowledge is important to prevent
Horner’s syndrome, which is ipsilateral
ptosis, miosis and facial anhidrosis.
6. Kuntz’s nerve is the intrathoracic nerve,
which arises from approximately T2 and
bypasses the sympathetic chain to the lower brachial plexus.
7. En bloc T2-T3 gangionectomy with
ablation of the Kuntz’s nerve can provide a
nearly complete autonomic innervation of
the upper extremity.
4. Excision of the axillary gland is also used.
5. Thoracic thoracoscopic sympathecomy has
success rate of 90% for hyperhidrosis.
6. Sympathectomy is rarely indicated for
Raynaud’s syndrome, Berger’s disease,
long QT syndrome, refractory angina.
5. The rami of T2 and T3 are hemoclipped and divided.
6. The sympathetic chain was hemoclipped and divided proximally and distally.
7. The T2 and T3 are removed en bloc.
8. The bodies of 2nd and 3rd ribs are scored horizontally with cautery from the costovertebral angle laterally 3-4 cm.
9. A chest tube is not needed if hemostasis is adequate.