Thoracoscopic and Anatomic Landmarks of Kuntz's Nerve: Implications for Sympathetic Surgery Franz Marhold, MD, Barbara Izay, MS, Johannes Zacherl, MD,

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Presentation transcript:

Thoracoscopic and Anatomic Landmarks of Kuntz's Nerve: Implications for Sympathetic Surgery Franz Marhold, MD, Barbara Izay, MS, Johannes Zacherl, MD, Manfred Tschabitscher, MD, Christoph Neumayer, MD The Annals of Thoracic Surgery Volume 86, Issue 5, Pages 1653-1658 (November 2008) DOI: 10.1016/j.athoracsur.2008.05.080 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Right upper thoracic cavity, thoracoscopic view without dissection shows mild thickening of the parietal pleura postmortem. (B) Same right upper thoracic cavity as in A after anatomic dissection. (1 = nerve of Kuntz; 2 = superior intercostal vein medially to the nerve of Kuntz; 3 = second rib; 4 = second thoracic nerve; 5 = first rib; 6 = first thoracic nerve; TS = sympathetic trunk.) The Annals of Thoracic Surgery 2008 86, 1653-1658DOI: (10.1016/j.athoracsur.2008.05.080) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Right upper thoracic cavity after anatomic dissection with nerve of Kuntz on the second rib (type A in the classification of Ramsaroop [17]), with the superior intercostal vein medial to the nerve of Kuntz. (1 = nerve of Kuntz; 2 = superior intercostal vein medially to the nerve of Kuntz; 3 = second rib; 4 = second thoracic nerve; 5 = first rib; 6 = first thoracic nerve; 7 = communicating ramus from the TS to the first thoracic nerve; 8 = descending communicating ramus from TS to the nerve of Kuntz; TS = sympathetic trunk; TSG = sympathetic trunk ganglion.) The Annals of Thoracic Surgery 2008 86, 1653-1658DOI: (10.1016/j.athoracsur.2008.05.080) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Left upper thoracic cavity after anatomic dissection with nerve of Kuntz on the second rib (type A in the classification of Chung [16], and type B in the classification of Ramsaroop [17]), with the superior intercostal vein medial to the nerve of Kuntz. (1 = nerve of Kuntz; 2 = superior intercostal vein medial to the nerve of Kuntz; 3 = second rib; 4 = second thoracic nerve; 5 = first rib; 6 = first thoracic nerve; 7 = communicating ramus from TSG to first thoracic nerve; 8 = descending communicating ramus from TSG to second thoracic nerve; 9 = edge of the dissected parietal pleura; TS = sympathetic trunk; TSG = sympathetic trunk ganglion.) The Annals of Thoracic Surgery 2008 86, 1653-1658DOI: (10.1016/j.athoracsur.2008.05.080) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions