ORIENTATION LANDMARKS OF ENDOSCOPIC TRANSAXILLARY T-2 SYMPATHECTOMY FOR PALMAR HYPERHIDROSIS

The identification of the T-2 ganglion through a narrow operative view field is the greatest challenge in performing endoscopic transaxillary T-2 sympathectomy, especially for a surgeon who is unfamiliar with th e technique. The authors describe a simple anatomical method for ident ifying the T-2 ganglion during the operation, based on a study of 17 a dult cadavers. First, a similar clinical procedure was performed along the anterior or middle axillary line via the second to fourth interco stal spaces to measure the aiming angles and intrathoracic depth neede d. Second, the regional anatomical structures and their relationship t o bilateral T-2 ganglia were delineated. It was discovered that the su perior intercostal artery, a branch of the subclavian artery, was an a ccessible landmark. This small vessel existed in 87.5% of the cadavers studied. It consistently runs lateral to the parallel sympathetic cha in at an average distance of 10 mm. Most important is that it can be e asily distinguished where it runs across the inner part of the second rib. The authors emphasize that the superior intercostal artery should be a very beneficial landmark for surgical orientation.