Thoracoscopic Splanchnicectomy

Operation may be done on only one side or bilaterally. The left side is divided for midline or left-sided pain. For predominantly right-sided pain the right is selected. The lateral position is preferred for a unilateral operation, prone for a bilateral procedure. After completion on one side with reexpansion of the lung the other side is done.

Two to three 5 mm ports are used. The chest is entered using the Optiview 5 mm trochar just below the scapula. A second port is used for the cautery or harmonic scapel. A third port may be necessary for retraction. CO2 is insulflated into the chest obviating the need for split lung ventilation. At the conclusion of the case CO2 is turned off, the patient is bag ventilated inducing a Valsalva and the last port is removed with the suction on. This results in minimal residual pneumothorax. In most cases this can be ohserved without chest tube placement as the CO2 will readily be absorbed.

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