Surgical techniques for the realization of thoracic sympathectomy

Abstract

With the advent of video and advancement in endoscopic video-assisted techniques, the thoracoscopic approach, first described by Kux in 1951, has undergone rapid progression and is now widely accepted as the approach of choice to perform sympathectomy. Other discussions have arisen regarding the technique used: to cut, clip, or resect the upper thoracic sympathetic chain is accepted as the approach of choice, with minimal postoperative morbidity and near faultless success rate, but the optimal technique remains a subject of controversy. Some authors prefer either resection of the chain, or clipping the chain, while others prefer electrocautery ablation of the ganglia. The uniportal technique has now emerged, in an effort to minimize surgical trauma and speed up the procedure. In this chapter we discuss all of the techniques used, considering discussion and concerns arising about them, and describe their final results.