Application of preoperative rib classification based on chest CT imaging for rib localization in ETS

XU Gang; HU Chaoyue; ZHU Daolong; LIU Han; LIN Yuancai; CHEN Cong; WANG Dong

doi:10.3969/j.issn.1002-266X.2025.03.006

Abstract：Objective To evaluate the application effect of preoperative rib classification based on chest CT imaging for rib localization during endoscopic thoracic sympathectomy(ETS).Methods A total of 1,008 patients with primary palmar hyperhidrosis(PPH)undergoing ETS were enrolled.Preoperative chest CT scans were performed,and patients were classified into three rib types based on CT imaging:Type 1(normal rib anatomy,754 cases),Type 2(first rib visi-ble at the thoracic apex,31 cases),and Type 3(second rib partially visible,223 cases).Intraoperative visual inspection or mobile C-arm X-ray imaging was used to verify the accuracy of preoperative rib classification.Results All 1,008 pa-tients successfully underwent ETS.Intraoperative visual inspection or radiographic examination confirmed that the preoper-ative rib classification was accurate in all 1,008 cases,achieving a preoperative rib classification accuracy rate of 100%.Among the 754 patients preoperatively classified as Type 1,intraoperative visual inspection confirmed that all cases were Type 1,with no discrepancies.For the 31 patients preoperatively classified as Type 2,intraoperative visual inspection identified 26 cases as Type 2,while 5 cases were difficult to distinguish visually and were subsequently confirmed as Type 2 by intraoperative C-arm X-ray imaging.Among the 223 patients preoperatively classified as Type 3,intraoperative visual inspection identified 204 cases as Type 3,while 19 cases were difficult to distinguish visually and were confirmed as Type 3 after intraoperative radiographic examination.Conclusion For PPH patients who undergo ETS,preoperative rib classi-fication based on chest CT imaging demonstrates high accuracy for rib localization.