Sympathetic denervation of the upper extremity is commonly done by interruption of or resection of the sympathetic ganglia/chain at T2±T3 . Currently, this is surgically performed mostly through a video assisted thoracoscopic approach, with a resultant unavoidable pleural violation, but with the advantage of being minimally invasive. Historically, neurosurgeons approached the sympathetic chain posteriorly through an open approach.

     An endoscopic posterior approach would avoid pleural entry and at the same time is minimally invasive and has an extra advantage of ability to be performed bilaterally from the same approach. A detailed cadaveric study is lacking.

     Five lightly embalmed cadavers ( 10 sides, age 18 -75 ) were used to study the approach.

     18 mm Metrx tubular retractor was used under fluoroscopic guidance to bank on the traverse process-head of the rib junction. Depth of drilling, craniocaudal extent of drilling, pleural violation, and visibility of sympathetic chain were all assessed.

     Sympathetic chain visibility and exposure was possible in 100 % of sides with adequate degree of freedom to manipulate the chain for the purpose of interruption. Ideal exposure was achieved by drilling more of the transverse process than the head of the rib. Depth of drilling ranged from 1-3 cm with a mean of 2.1 cm, craniocaudal exposure ranged from 8-16 mm with a mean of 11.5 mm. Pleural violation occurred in one side.

     This is a cadaveric analysis.

     Endoscopic assisted posterior sympathectomy is feasible in a cadaveric settings.

     It carries the potential advantage of avoiding pleural entry and bilaterality.