(1)
Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
(2)
Department of Paediatric Surgery, Birmingham Children’s Hospital, Birmingham, UK
Abstract
The main indication for the thoracoscopic sympathectomy is hyperhidrosis: excessive sweating in amounts greater than physiologically needed for thermoregulation. Adolescents usually complain of palmar hyperhidrosis, but axillary, plantar, and craniofacial sites can also be involved.
Keywords
HyperhidrosisSympathetic chainThorascopic6.1 General Information
The main indication for the thoracoscopic sympathectomy is hyperhidrosis: excessive sweating in amounts greater than physiologically needed for thermoregulation. Adolescents usually complain of palmar hyperhidrosis, but axillary, plantar, and craniofacial sites can also be involved.
For palmar hyperhidrosis, the sympathetic chain over ribs two to four is resected.
6.2 Working Instruments
0 degree 5-mm or 30 degree 5-mm telescope
3-, 5-mm ports
5-mm hook cautery
5-mm scissors, Johans (straight) or Kelly (curved) grasping forceps
Suction
6.3 Positioning, Port Siting, and Ergonomic Considerations
The patient is placed in the lateral position on top of an axillary roll. The monitor is positioned above the patient’s head. The first port is placed anterior to the inferior angle of the scapular. A pneumothorax of 6 mmHg is established with flows of 1.5 L/min. The second and third ports are placed in the fourth or fifth intercostal space in the mid-axillary line and posteriorly.
6.4 Relevant Anatomy
The sympathetic chain runs vertically over the necks of the ribs in the upper costovertebral region under the parietal pleura. It lies just lateral to the superior intercostal vein. The stellate ganglion lies above and below the neck of rib one, deep to a yellow fat pad just inferior to the subclavian artery (Fig. 6.1).
