Minimal Access Posterior Approach for Extrapleural Thoracic Sympathectomy

A Cadaveric Study and Cases

Jeffrey S. Raskin, Jesse J. Liu, Hai Sun, Andrew Nemecek, Seshadri Balaji, Ahmed Raslan

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective Operatively, video-assisted thoracoscopic sympathectomy (VATS) involves pleural entry and poses risk in small children and 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 using this approach are discussed: case 1, a 9-year-old girl with refractory long QT syndrome; and case 2, a 13-year-old boy with hypertrophic cardiomyopathy. Results The cadaveric study supported 100% identification of a craniocaudal-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. Conclusions 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 2 preliminary cases, we believe that a posterior minimal access approach allows safe and effective access to the thoracic sympathetic chain for causes requiring sympathectomy using single positioning, with minimal risk of pneumothorax or Horner syndrome.

Original languageEnglish (US)
Pages (from-to)490
Number of pages1
JournalWorld Neurosurgery
Volume93
DOIs
StatePublished - Sep 1 2016

Fingerprint

Sympathectomy
Thorax
Cardiac Arrhythmias
Pediatrics
Horner Syndrome
Long QT Syndrome
Hypertrophic Cardiomyopathy
Feasibility Studies
Pneumothorax
Secondary Prevention
Cadaver
Lung Diseases

Keywords

  • Cadaver
  • Minimal access
  • Posterior sympathectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Minimal Access Posterior Approach for Extrapleural Thoracic Sympathectomy : A Cadaveric Study and Cases. / Raskin, Jeffrey S.; Liu, Jesse J.; Sun, Hai; Nemecek, Andrew; Balaji, Seshadri; Raslan, Ahmed.

In: World Neurosurgery, Vol. 93, 01.09.2016, p. 490.

Research output: Contribution to journalArticle

@article{d7692a4ba8184b94a570f497841e30e8,
title = "Minimal Access Posterior Approach for Extrapleural Thoracic Sympathectomy: A Cadaveric Study and Cases",
abstract = "Objective Operatively, video-assisted thoracoscopic sympathectomy (VATS) involves pleural entry and poses risk in small children and 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 using this approach are discussed: case 1, a 9-year-old girl with refractory long QT syndrome; and case 2, a 13-year-old boy with hypertrophic cardiomyopathy. Results The cadaveric study supported 100{\%} identification of a craniocaudal-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. Conclusions 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 2 preliminary cases, we believe that a posterior minimal access approach allows safe and effective access to the thoracic sympathetic chain for causes requiring sympathectomy using single positioning, with minimal risk of pneumothorax or Horner syndrome.",
keywords = "Cadaver, Minimal access, Posterior sympathectomy",
author = "Raskin, {Jeffrey S.} and Liu, {Jesse J.} and Hai Sun and Andrew Nemecek and Seshadri Balaji and Ahmed Raslan",
year = "2016",
month = "9",
day = "1",
doi = "10.1016/j.wneu.2016.06.072",
language = "English (US)",
volume = "93",
pages = "490",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Minimal Access Posterior Approach for Extrapleural Thoracic Sympathectomy

T2 - A Cadaveric Study and Cases

AU - Raskin, Jeffrey S.

AU - Liu, Jesse J.

AU - Sun, Hai

AU - Nemecek, Andrew

AU - Balaji, Seshadri

AU - Raslan, Ahmed

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Objective Operatively, video-assisted thoracoscopic sympathectomy (VATS) involves pleural entry and poses risk in small children and 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 using this approach are discussed: case 1, a 9-year-old girl with refractory long QT syndrome; and case 2, a 13-year-old boy with hypertrophic cardiomyopathy. Results The cadaveric study supported 100% identification of a craniocaudal-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. Conclusions 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 2 preliminary cases, we believe that a posterior minimal access approach allows safe and effective access to the thoracic sympathetic chain for causes requiring sympathectomy using single positioning, with minimal risk of pneumothorax or Horner syndrome.

AB - Objective Operatively, video-assisted thoracoscopic sympathectomy (VATS) involves pleural entry and poses risk in small children and 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 using this approach are discussed: case 1, a 9-year-old girl with refractory long QT syndrome; and case 2, a 13-year-old boy with hypertrophic cardiomyopathy. Results The cadaveric study supported 100% identification of a craniocaudal-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. Conclusions 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 2 preliminary cases, we believe that a posterior minimal access approach allows safe and effective access to the thoracic sympathetic chain for causes requiring sympathectomy using single positioning, with minimal risk of pneumothorax or Horner syndrome.

KW - Cadaver

KW - Minimal access

KW - Posterior sympathectomy

UR - http://www.scopus.com/inward/record.url?scp=84987916161&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84987916161&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2016.06.072

DO - 10.1016/j.wneu.2016.06.072

M3 - Article

VL - 93

SP - 490

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -