TRANSTHORACIC VIDEO ENDOSCOPIC ELECTROCAUTERY OF SYMPATHETIC-GANGLIA FOR HYPERHIDROSIS PALMARIS - SPECIAL REFERENCE TO LOCALIZATION OF THE FIRST AND 2ND RIBS

BACKGROUND The surgical technique for transthoracic endoscopic sympath ectomy varies from one to three skin incisions, room air to carbon dio xide pneumothorax, and destruction of the second (T-2), third (T-3), a nd fourth sympathetic ganglia to destruction of the T-2 ganglion only. A knowledge of the surgical anatomy of the apex may help the surgeon to safely use this technique. METHODS Forty-seven patients with palmar hyperhidrosis underwent video-assisted endoscopic electrocautery of t he T-2 and T-3 ganglia with the use of one-lumen endotracheal tube for general anesthesia, one skin incision, and carbon dioxide pneumothora x. Surgical anatomy, palm temperature, and surgical results were analy zed. RESULTS The first ribs of 23 patients were endoscopically visible and most of these first ribs were not as parallel to the second ribs as the third ribs were. The first ribs of the remaining 24 patients we re palpable with a diathermy bar. In all but three patients with dense pulmonary adhesions, the distal end of the intrathoracic segment of t he subclavian artery was seen to pierce the pleura at the upper border of the first rib. Ninety-one palms remain dry and 27 patients develop compensatory sweating in an average follow-up of 12 months. Excluding three patients whose sympathetic ganglia could not be electrocauteriz ed because of severe pulmonary adhesions, 95% of the remaining 44 pati ents are satisfied with the results. CONCLUSIONS Transthoracic video e ndoscopic electrocautery of the T-2 and T-3 ganglia for patients with palmar hyperhidrosis may yield excellent results if the first rib can be properly identified. (C) 1997 by Elsevier Science Inc.