Thoracoscopic sympathectomy

Author - Dr Jeremy Langton

Date published - 21 September 2011

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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

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