Thoracoscopic sympathectomy
Author - Dr Jeremy Langton
Date published - 21 September 2011
Indications
- Usually performed for sweaty palms / axillae, occasionally for upper limb ischaemia
- Sympathetic trunk is divided at T2/3 via a thoracoscope inserted via a small axillary incision
- Patients are usually fit and well
Position
- Supine with the affected arm out on a board in the reverse trendelenberg position
- Head up position also common
Ventilation
- One lung ventilation using a double lumen tube, collapse the lung on the affected side.
- Alternately LMA with passive collapse of lung using CO 2
Pain relief
- Simple analgesics plus local anaesthetic infiltration by the surgeon (? Down the thoracoscope)
Post op
- Need chest x ray to check for lung re-inflation and pneumothorax
