DORSAL SYMPATHECTOMY AND MANAGEMENT OF THORACIC OUTLET SYNDROME WITH VATS

Dorsal sympathectomy and the management of the thoracic outlet syndrom e have been considerably improved with the use of video assistance bec ause it affords both magnification and an improved light system. Two t echniques of video assistance were employed in the group of patients d escribed here. One involved the sympathectomy done through three ports using standard video-assisted thoracic surgical methods. The second t echnique involved a transaxillary incision with removal of the first r ib using video-assistance magnification and light, operating either di rectly or secondarily while visualizing the image on the television se t. (The vast majority of cases have been performed using this latter t echnique.) Major indications for performing dorsal sympathectomy inclu de (1) hyperhidrosis, (2) Raynaud's phenomenon, (3) Raynaud's disease, (4) causalgia, (5) reflex sympathetic dystrophy, and (6) vascular ins ufficiency of the upper extremity. Except for hyperhidrosis, all of th e other indications require the usual diagnostic techniques, including cervical sympathetic blockade to assess whether the symptoms are reli eved by temporary blockade of the sympathetic ganglia. In 326 patients , sympathectomy, performed either alone or in conjunction with first-r ib removal for relief of the thoracic outlet syndrome, has been succes sful. In only 6 patients has sympathetic activity recurred in less tha n 6 months. Initially all of them were treated conservatively. Three o f the 6 required a repeat sympathectomy. Postsympathectomy neuralgia o ccurred in only 2 of more than 326 patients. Both cases were managed s uccessfully in a conservative fashion. Among the patients in whom a Ho rner's syndrome was not deliberately induced, the syndrome developed i n 2. In both, the syndrome resolved spontaneously within several month s.