CPT® Code 64804

1. Indications

The cervicothoracic sympathectomy is performed for several specific medical conditions that are influenced by the sympathetic nervous system. The following indications are explicitly associated with this procedure:

• 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 cervicothoracic sympathectomy involves several critical procedural steps that ensure the effective division of the sympathetic chain. The following steps outline the procedure:

• Step 1: Incision - An incision is made in the neck or chest at the appropriate level to access the cervicothoracic sympathetic chain. This incision allows the surgeon to reach the targeted area effectively.
• Step 2: Dissection - Tissues surrounding the sympathetic chain are carefully dissected to expose the nerve fibers. In some cases, the lung may be deflated to provide better visualization of the thoracic structures, facilitating the surgical approach.
• Step 3: Identification and Division - The sympathetic chain is located and divided using electrocautery, which serves to cut and coagulate the nerve fibers. Alternatively, a segment of the sympathetic chain may be excised to achieve the desired outcome.
• Step 4: Obliteration of Ganglia - The ganglia associated with the sympathetic chain are completely obliterated, ensuring that the sympathetic chain is fully severed and preventing any potential regrowth of nerve fibers.
• Step 5: Management of Aberrant Nerve Bundles - During the procedure, any aberrant nerve bundles that may be present are identified and severed to ensure complete interruption of sympathetic nerve activity.
• Step 6: Cauterization - The ends of the separated sympathetic nerve bundles are cauterized to prevent regrowth, further ensuring the effectiveness of the procedure.
• Step 7: Closure - Once the transection is complete, the lungs are re-expanded, a chest tube is placed if necessary, and the chest incision is closed to complete the surgical intervention.

3. Post-Procedure

After the cervicothoracic sympathectomy, patients may require monitoring for any complications related to the procedure. Expected recovery may involve managing pain and ensuring proper lung function, particularly if a chest tube was placed. Patients are typically advised on post-operative care, including activity restrictions and signs of potential complications that should prompt immediate medical attention. Follow-up appointments are essential to assess the effectiveness of the procedure and to monitor for any adverse effects.