Awake Thoracic Surgery

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Awake thoracic surgery is a new surgical field that is set to expand in the near future. Employing sole epidural or local anaesthesia in fully awake patients renders many thoracic surgical procedures ...
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Awake Thoracoscopic Sympathectomy

Pp. 177-190 (14)

Maria Elena Cufari, Eugenio Pompeo, Tommaso Claudio Mineo and Vincenzo Ambrogi


Video-Assisted Thoracic Surgery (VATS) sympathectomy is a safe and effective procedure for treatment of facial, palmar and axillary hyperhidrosis. It can be more rarely used in other conditions. Awake thoracic surgery with epidural anesthesia and spontaneous ventilation has been employed to perform many surgical procedures including VATS sympathectomy.

This chapter describes the anatomy of the nerve with the most frequent abnormalities, the indications and contraindication for both sympathectomy and awake surgery, the method for awake anesthesia, a detailed step-by-step description of the surgical technique and postoperative management as well as an analysis of benefits and potential side-effects of awake VATS sympathectomy.

Patient selection, choice of the level of sympathectomy and adequate information about anesthesia and side effects of the operation are extremely important for the good result of the procedure.

Awake VATS sympathectomy may be considered a globally minimally invasive approach combining avoidance of general anesthesia-related adverse effects with maximum patient satisfaction.


Sympathectomy, VATS, awake thoracic surgery, hyperhidrosis, local anesthesia, thoracic epidural anesthesia.


Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.