Abstract
Purpose
Understanding the precise anatomy of the upper thoracic sympathetic trunk is crucial for the effective treatment of palmar hyperhidrosis using the surgical technique of endoscopic thoracic sympathectomy (ETS). The variability in the location of T2 and T3 ganglia in relation to the ribs may contribute to inconsistent clinical outcomes following ETS. Traditionally, a rib-oriented approach has been used, relying on the positions of the second, third, and fourth ribs as landmarks rather than the actual ganglia positions, potentially leading to incomplete or inaccurate ganglion destruction. This study is undertaken to advocate for a ganglion-oriented approach to ETS, which necessitates an accurate anatomical understanding of the T2 and T3 ganglia locations.
Methods
For the study, 40 human cadaveric thoraces were dissected to map the locations of T2 and T3 ganglia relative to the ribs.
Results
The findings showed a high percentage of T2 ganglion is located near the superior border of the third rib, while the T3 ganglion is situated near the fourth rib. Specifically, 43% of the right T2 ganglia and 38% of the left T2 ganglia were in contact with the superior part of the third rib. These results indicate a significant risk of inadvertently damaging the T2 ganglion when using a rib-oriented approach at the third rib level leading to compensatory hyperhidrosis.
Conclusion
Due to the proximity of the T2 ganglion to the third rib, accidental thermal injury to the ganglion may occur when third rib-oriented ETS is performed. A ganglion-oriented T3 ETS can be performed by using the white ramus communicans as a guide to accurately locate the T3 ganglion, ensuring precise sympathectomy and preserving sympathetic innervation to the heart and face. Adopting the ganglion-oriented sympathectomy could standardize ETS procedures and enhance the comparability of surgical outcomes.