For many years I have been dissatisfied with surgical approaches and techniques which were advocated for sympathetic denervation of the head, neck, shoulder, chest, upper extremity, heart, and coronary circulation. These left much to be desired, from the standpoint both of the surgeon and of the patient. Frequently the operation was difficult to perform and usually resulted in incomplete denervation, so that the desired physiologic changes did not occur. Moreover, the exposure was difficult and inadequate, making it impossible in many cases to cope with any variations which might exist, either in the sympathetic components or in the vascular channels in the operative area. Also, the extent of resection of the sympathetic fibers did not result in a complete ablation of the essential pathways.
For the reasons noted above and many other factors, I developed and began to utilize, in April, 1953, an anterior transthoracic transpleural approach through
PALUMBO LT. New Surgical Approach for Upper Thoracic SympathectomyA Method to Avoid Horner's Syndrome. AMA Arch Surg. 1958;76(5):807-810. doi:10.1001/archsurg.1958.01280230147022