Microinvasive transaxillary thoracoscopic sympathectomy: Technical note

OBJECTIVE: To describe a two-port transaxillary thoracoscopic approach for thoracic sympathectomy that maximizes working space, improves manipulative ability, and enhances visualization of the surgical field. METHODS: Positioning of the patients was optimized to displace the scapula posteriorly, widen the avenue of approach to the sympathetic ganglia, and create a more direct route to the target. The semi-fowler position permitted the lung apex to fall away from mediastinal structures, obviating a separate retraction port. A 30-degree endoscope allowed an unobstructed view of surgical progress, and anatomic relationships were manipulated in a temporal sequence to facilitate dissection. RESULTS: Microinvasive transaxillary sympathectomy was performed successfully in 13 patients, all of whom had a good outcome without complications. CONCLUSION: The modifications implemented increase the speed and safety of thoracoscopic sympathectomy while minimizing complications.