Visualization of the thoracic sympathetic chain in MLS embalmed body donors: a feasibility study and surgical perspective

Background: Thoracoscopic sympathetic interruption (TSI) is a definitive treatment for sympathetically mediated disorders, like primary hyperhidrosis. Surgical success is associated with precise anatomical knowledge, appropriate level selection, and recognition of anatomical variants such as alternate neural pathways (ANP). Realistic wet-lab training is essential but often limited by cost and tissue fidelity. This study aimed to evaluate the feasibility of using body donors embalmed with Modified Larssen Solution (MLS) for visualization of the thoracic sympathetic trunk from a surgical perspective.

Methods: A single female body donor embalmed using MLS underwent a comprehensive thoracic dissection, including exposure of the sympathetic trunk, ganglia, rami communicantes, and potential ANP. Current literature was analyzed to address anatomical and clinical aspects, potential pitfalls, and the economic aspects of using MLS-embalmed body donors for TSI training and research.

Results: In our dissection, MLS embalming provided excellent visual and tactile tissue fidelity, allowing clear identification of thoracic sympathetic structures without detectable ANP. Cost analysis revealed chemical fixation expenses of 73.80 € per donor, markedly lower than conventional methods such as Thiel fixation. Literature suggests that selective, anatomically guided TSI may optimize symptom control while potentially reducing adverse effects. Current literature suggests that procedural precision, detailed anatomical knowledge, and tissue-sparing techniques are associated with improved clinical outcomes.

Conclusions: While TSI is an established procedure requiring precise anatomical knowledge, the present study is limited to a single-specimen feasibility assessment. The MLS-embalmed body donor demonstrated promising visual and tactile characteristics in this setting; however, their suitability for surgical training and their impact on procedural performance or clinical outcomes remain to be systematically evaluated.