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Neurosurgery (68)
Author(s) -
Wahlig John B.,
Welch William C.,
Weigel Tracey L.,
Luketich James D.
Publication year - 2001
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/j.1533-2500.2001.1011-68.x
Subject(s) - sympathectomy , medicine , hyperhidrosis , thoracoscopy , neurosurgery , surgery , port (circuit theory) , dissection (medical) , engineering , electrical engineering
Microinvasive transaxillary thoracoscopic sympathectomy: technical note. (Presbyterian University Hospital, Pittsburgh, PA) Neurosurgery 2000;46:1254–1258. This report describes 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. Conclude the modifications implemented increase the speed and safety of thoracoscopic sympathectomy while minimizing complications. Comment by R. Ruiz‐López, MD. Thoracic sympathectomy is an accepted means of treating hyperhidrosis, Raynaud's disease, causalgia major and other autonomically mediated syndromes. The authors describe a two‐port transaxillary thoracoscopic approach that maximizes working space, improves manipulative ability, and enhances visualization of the surgical field, advocating a lateral decubitus semi‐Fowler position. A total of 13 patients were treated, 11 with reflex sympathetic dystrophy (complex regional pain syndrome type I (CRPS I)) and 2 with palmar hyperhidrosis. Interestingly, the authors excellent outcomes for CRPS I, not reflecting the experience of most practitioners. Thoracoscopic sympathectomy is evolving quickly since first described by Klux in 1951. From a technical standpoint, the authors describe a useful procedure of endoscopic thoracic sympathectomy that is worthy of further investigation as the series is limited to only 13 patients and in a larger series come complications would be encountered.