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The sympathetic chains were interrupted at the third and fourth ribs with harmonic scissors (Harmonic Scissors ACE7® + Laparoscopic Shears HARH45, Ethicon Endo-Surgery, Cincinnati, OH, 45242–2839 USA). We used a harmonic scalpel instead of a monopolar scalpel to achieve a more selective lesion41,42. Bleeding from any nearby vessels was controlled by clip application.
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