Thoracic Outlet Syndrome

---

Conference Name: Thoracic Webinar Series

Surgeon(s)/Speaker(s): Dr. Ali Zamir Khan

Surgical Procedure: Thoracic-Lungs - Sympathectomy

Location: Medanta- The Medicity Hospital Gurgaon

---

Indexsteps

1. General anaesthesia : General anaesthesia with single lumen tube.

2. Patient supine with 15 degrees head up tilt of table. : Patient supine with 15 degrees head up tilt of table.

3. Both chest cleaned and prepared from neck to subcostal margins and laterally to posterior axillary lines : Both chest cleaned and prepared from neck to subcostal margins and laterally to posterior axillary lines.

4. 10mm incision in right 5th intercostal space in anterior axillary line : 10mm incision in right 5th intercostal space in anterior axillary line.

5. Muscle split : Muscle split with artery forceps.

6. Blunt 10mm trocar and cannula inserted : Blunt 10mm trocar and cannula inserted.

7. Carbon dioxide at 12mm Hg pressure insufflated till partial collapse of lung achieved : Carbon dioxide at 12mm Hg pressure insufflated till partial collapse of lung achieved.

8. 2nd to 4th ribs identified : 2nd to 4th ribs identified.

9. Sympathetic chain identified : Sympathetic chain identified.

10. 5mm incision with trocar and cannula insertion at 2nd intercostal space mid clavicular line : 5mm incision with trocar and cannula insertion at 2nd intercostal space mid clavicular line.

11. Sympathetic chain cut at T3 level : Sympathetic chain cut at T3 level.

12. Nerve of Kuntz cauterized along the rib : Nerve of Kuntz cauterized along the rib.

13. CO2 released : CO2 released.

14. Lung inflated : Lung inflated.

15. Ports closed : Ports closed.

16. Procedure repeated on left side. : Procedure repeated on left side.