Minimal access posterior approach for extrapleural thoracic sympathectomy: a cadaveric study and cases.

Minimal access posterior approach for extrapleural thoracic sympathectomy: a cadaveric study and cases.

World Neurosurg. 2016 Jun 25;

Authors: Raskin JS, Liu JJ, Sun H, Nemecek A, Balaji S, Raslan AM

Abstract
OBJECTIVE: Operatively, video-assisted thoracoscopic sympathectomy (VATS) involves pleural entry and poses risk in small children, and in patients with pulmonary disease. A conventional posterior sympathectomy is more invasive than VATS. We investigated a cadaveric feasibility study of a minimal access posterior approach for endoscopic extrapleural sympathectomy and discuss this minimal approach in children with cardiac sympathectomy.
METHODS: A posterior endoscopic extrapleural approach for thoracic sympathectomy was performed using lightly embalmed cadavers; surgical corridor depth, width, and associated pleural violation were recorded. Two pediatric cases undergoing secondary prevention for breakthrough cardiac dysrhythmias utilizing this approach are discussed in brief; case 1- a 9-year old female with refractory long QT syndrome, and case 2- a 13-year old male with hypertrophic cardiomyopathy.
RESULTS: The cadaveric study supported 100% identification of cranial-caudal oriented sympathetic chain using an 18 mm tubular retractor, and a 10% pleural violation rate. There were no clinically significant pneumothoracies in either proof of concept cases.
CONCLUSION: Minimal access posterior extrapleural sympathectomy is feasible to expose the sympathetic chain in the thoracic region with good visualization using either endoscopic or microscopic magnification. Single position bilateral thoracic sympathectomy can be performed in pediatric patients with life threatening ventricular arrhythmias. Based on the cadaveric study and the two preliminary cases, we believe a posterior minimal access approach allows safe and effective access to the thoracic sympathetic chain for etiologies requiring sympathectomy using single positioning with minimal risk of pneumothorax or Horner's syndrome.

PMID: 27353558 [PubMed - as supplied by publisher]

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