# T3 Endoscopic Thoracic Ganglionectomy Using Cutting Mode Cautery for Palmar Hyperhidrosis

## TL;DR

This study examines the anatomy of thoracic ganglia to improve surgery for palmar hyperhidrosis, showing better outcomes with T3 ganglionectomy.

## Contribution

The study introduces a T3 ganglionectomy technique using anatomical landmarks to enhance surgical precision and reduce complications.

## Key findings

- T3 ganglionectomy was performed on 74 pediatric patients with complete satisfaction and no compensatory sweating.
- T2 ganglia are often near the third rib, increasing risk of accidental injury during surgery.
- Using the white ramus communicans as a guide improves accurate localization of the T3 ganglion.

## Abstract

Understanding the precise anatomy of the upper thoracic sympathetic trunk is crucial for effectively treating 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 after ETS.

For the cadaver study, adult human cadaveric thoraces were dissected to map the locations of T2 and T3 ganglia by identifying their white rami communicantes. For the ETS group, T3 ganglionectomy ETS was performed. Surgical outcome and postoperative incidence of compensatory sweating were assessed.

A total of 74 pediatric patients underwent thoracoscopic T3 ganglionectomy. All patients were satisfied with the surgical outcomes. No patients complained of compensatory sweating. Forty cadavers were dissected: 25 adult female and 15 adult male. The findings showed that a high percentage of T2 ganglia are near the superior border of the third rib, while the T3 ganglion is near the fourth rib.

Because of the proximity of the T2 ganglion to the third rib, accidental thermal injury to the T2 ganglion may occur when third rib-oriented ETS is performed. A ganglion-oriented T3 ETS can be accomplished by using the white ramus communicans as a guide to accurately locate the T3 ganglion.