Robotic Selective Postganglionic Thoracic Sympathectomy for the Treatment of Hyperhidrosis Hans Coveliers, MD, Mark Meyer, MD, Farid Gharagozloo, MD,

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Presentation transcript:

Robotic Selective Postganglionic Thoracic Sympathectomy for the Treatment of Hyperhidrosis Hans Coveliers, MD, Mark Meyer, MD, Farid Gharagozloo, MD, Willem Wisselink, MD, PhD, Jan Rauwerda, PhD, Marc Margolis, MD, Barbara Tempesta, CRNP, Eric Strother, CSA The Annals of Thoracic Surgery Volume 95, Issue 1, Pages 269-274 (January 2013) DOI: 10.1016/j.athoracsur.2012.08.013 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Numbers 1, 2, and 3 indicate incisions for port placement and robot positioning. CT indicates incision 4 for the chest tube. The Annals of Thoracic Surgery 2013 95, 269-274DOI: (10.1016/j.athoracsur.2012.08.013) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intraoperative photograph, (A) without and (B) with labels, depicts the division of the left T2 postganglionic nerve arising from the sympathetic chain. Labels #2 and #3 indicate 2nd and 3rd ribs, respectively. The Annals of Thoracic Surgery 2013 95, 269-274DOI: (10.1016/j.athoracsur.2012.08.013) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Diagram of the sympathetic chain from T2 to T4, which is a magnified view of the inset diagram as outlined by the box. Preganglionic fibers (blue) arise from the spinal cord and synapse via a ganglion (black) within the sympathetic chain to postganglionic fibers (red). A mixture of ganglia and interganglionic nerve fibers comprise the sympathetic bundle (yellow). Ascending communicating rami travel from the sympathetic ganglia to the intercostal nerve located superiorly. Descending communicating rami travel from the sympathetic ganglia to the intercostal nerve located inferiorly. Intercostal communicating rami travel between the intercostal nerves. The Annals of Thoracic Surgery 2013 95, 269-274DOI: (10.1016/j.athoracsur.2012.08.013) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions