Endoscopic Thoracic Sympathectomy: At What Level Should You Perform Surgery?

The literature is inundated with a plethora of procedures that are not standardized and are hard to compare. Several interventions on the sympathetic chain are possible and the nomenclature has been confusing. The authors propose a uniform naming for each procedure, mainly, sympathectomy for resection or ablation of the ganglion, sympathicotomy for the transaction of the chain, ramicotomy for the procedure preserving the chain and ganglia and severing the rami, and, finally, sympathetic block by clipping above and below the ganglia. The authors recommend intervention on the T2 ganglia for facial hyperhidrosis and rubor, on the T3 ganglia for palmar hyperhidrosis, and on the T3 and T4 ganglia for axillary hyperhidrosis.