CPT® Code 64802

1. Indications

The cervical sympathectomy procedure is indicated for several specific conditions that involve the sympathetic nervous system. These indications include:

• Hyperhidrosis - A condition characterized by excessive sweating, often requiring intervention to improve quality of life.
• Thoracic Outlet Syndrome - A condition that occurs when blood vessels or nerves in the thoracic outlet are compressed, leading to pain and discomfort.
• Reflex Sympathetic Dystrophy - A chronic pain condition that typically follows an injury, characterized by severe pain, swelling, and changes in skin color.
• Chronic Pancreatic Pain - Persistent pain associated with pancreatic disorders, which may be alleviated through sympathetic nerve interruption.

2. Procedure

The cervical sympathectomy procedure involves several critical steps to ensure effective treatment. The process begins with the patient being positioned appropriately, followed by the administration of anesthesia to ensure comfort during the surgery.

• Step 1: Incision - A surgical incision is made in the neck at the level where the cervical sympathetic chain is located. This incision allows access to the sympathetic nerves that need to be addressed.
• Step 2: Dissection - Surrounding tissues are carefully dissected to expose the sympathetic chain. In cases where a cervicothoracic sympathectomy is performed, the lung may be deflated to provide better visualization of the thoracic structures.
• Step 3: Identification and Division - The sympathetic chain is identified and divided using electrocautery, which serves to cut and coagulate the nerve fibers. Alternatively, a segment of the sympathetic chain may be excised entirely.
• Step 4: Obliteration of Ganglia - The ganglia are completely obliterated, ensuring that the sympathetic chain is fully severed. This step is crucial for achieving the desired therapeutic effect.
• Step 5: Management of Aberrant Nerve Bundles - For cervicothoracic sympathectomy, any aberrant nerve bundles are located and severed to prevent complications and ensure complete interruption of sympathetic nerve pathways.
• Step 6: Cauterization - The ends of the separated sympathetic nerve bundles are cauterized to prevent regrowth, which is essential for the long-term success of the procedure.
• Step 7: Closure - Once the transection is complete, the lungs are re-expanded, a chest tube may be placed if necessary, and the incision is closed to facilitate healing.

3. Post-Procedure

After the cervical sympathectomy, patients are typically monitored for any immediate complications. Post-procedure care may include pain management and monitoring for signs of infection or other adverse effects. Patients may be advised on activity restrictions and follow-up appointments to assess recovery and the effectiveness of the procedure. The expected recovery time can vary based on individual circumstances and the extent of the surgery performed.