Orientation landmarks of endoscopic transaxillary T-2 sympathectomy for palmar hyperhidrosis

Abstract

The identification of the T-2 ganglion through a narrow operative viewfield is the greatest challenge in performing endoscopic transaxillary T-2 sympathectomy, especially for a surgeon who is unfamiliar with the technique. The authors describe a simple anatomical method for identifying the T-2 ganglion during the operation, based on a study of 17 adult cadavers. First, a similar clinical procedure was performed along the anterior or middle axillary line via the second to fourth intercostal spaces to measure the aiming angles and intrathoracic depth needed. Second, the regional anatomical structures and their relationship to bilateral T-2 ganglia were delineated. It was discovered that the superior intercostal artery, a branch of the subclavian artery, was an accessible landmark. This small vessel existed in 87.5% of the cadavers studied. It consistently runs lateral to the parallel sympathetic chain at an average distance of 10 mm. Most important is that it can be easily 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.

Needlescopic thoracic sympathetic block by clipping for craniofacial hyperhidrosis

“…In most cases, they found that the upper margin of the T2 ganglion was at the second intercostal space near the upper border of the third rib [1]. In addition, the lower end of stellate ganglion is located at the second intercostal space near the lower margin of the second rib.…”

Repeat transthoracic endoscopic sympathectomy for palmar and axillary hyperhidrosis

“…The T2 sympathetic ganglion lies between the second and [9,10]. The superior intercostal artery plays a critical role in identifying the second rib [3,15]. This small vessel arising from the subclavian artery exists in 87.5% of the cadavers studied and consistently runs laterally and parallel to sympathetic chain at an average distance of 10 mm at the second rib [3].…”

“…The superior intercostal artery plays a critical role in identifying the second rib [3,15]. This small vessel arising from the subclavian artery exists in 87.5% of the cadavers studied and consistently runs laterally and parallel to sympathetic chain at an average distance of 10 mm at the second rib [3]. The second rib is just beneath the first intercostal muscle, offering another identification method.…”

Simpatectomía toracoscópica: una revisión de la literatura

“…Una vez identificada la cadena simpática como un cordón blanco que cruza perpendicularmente sobre el cuello de las costillas, es conveniente asegurarse del nivel mediante fluoroscopia (Figura 5) 10 . En pacientes con hiperhidrosis palmar, que es la indicación más frecuente, suele llevarse a cabo una lesión del ganglio simpático T2, que puede extenderse hasta los ganglios T3 y T4, aunque la mayoría de los autores coinciden en que no es necesario salvo hiperhidrosis axilar asociada, ya que podría incrementar la tasa y el grado de hiperhidrosis compensatoria y la sequedad de las manos 18,49,51 .…”