Hyperhidrosis is the only absolute indication. It gives good early results in Raynaud’s disease but symptoms return in 6-12 months. It may help in some circumstances in cervical rib syndrome, post-traumatic pain and causalgia. Thoracoscopic cervical sympathectomy, described here, is now the standard operation with open techniques, such as the transaxillary or supraclavicular approaches, rarely being required. Because the upper thoracic ganglia are ablated it should be correctly called a ‘thoracic sympathectomy’.
Chest x-ray to exclude pulmonary pathology that may prevent the establishment of a pneumothorax.
General with a double-lumen endotracheal tube
Supine with both arms abducted to 60°.
The azygos vein lies close to the sympathetic chain on the right side and requires careful mobilisation to expose the sympathetic chain.
The port sites are closed routinely.
A chest X-ray in the recovery area is performed to check for residual pneumothorax.
Include Horner’s syndrome if T1 is damaged. Also, compensatory hyperhidrosis.