Selective block of grey communicantes in upper thoracic sympathectomy. A feasibility study on human cadaveric specimens.

摘要: Background: Sympathetic chain interruption is the gold standard treatment for essential hyperhidrosis. Postoperative compensatory hyperhidrosis, main reason patients' dissatisfaction, reduced by selectively lesioning white and grey rami communicantes (ramicotomy).Objective: To develop an endoscopic surgical technique that interrupts only T3 T4 to minimize hyperhidrosis.Material Methods: ramicotomy in fifteen cold-preserved cadavers through a uniportal axillary approach. The sympathetic chain, its ganglia, were left intact. On opening chest, ganglia dissected, photographed, measured excised histological examination.Results: Dissecting feasible as they consistently lie between intercostal nerve homonymous ganglion. At some levels, Kuntz nerves, well more than one ramus communicans, can be found. White are medial, therefore damaging them avoided. Intercostal veins obstructive, but these controlled via coagulation or clipping if necessary.Conclusion: Uniportal selective excision of without communicantes, ganglia. Clipping technically possible not reliable due their thin diameter. This study confirms block feasible. Its application might reduce clinical studies needed.