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Li X, Liu Y, Zhou Y, Gao Y, Duan C, Zhang C. Day surgery unit robotics thoracic surgery: feasibility and management. J Cancer Res Clin Oncol 2023; 149:7831-7836. [PMID: 37037929 PMCID: PMC10088762 DOI: 10.1007/s00432-023-04731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Day surgery has been widely carried out in medical developed countries such as Europe and the United States with high efficiency, safety and economy. The development of thoracic day surgery started late, and currently only a few top three hospitals carry thoracic day surgery. In recent years, with the continuous in-depth application of the concept of accelerated rehabilitation surgery (ERAS) in the field of surgery, thoracic surgery ERAS has also entered clinical practice with remarkable results. At present, the application of day surgery in the field of thoracic surgery is still in its infancy, and the application of robot-assisted thoracic surgery in thoracic surgery has brought new opportunities for the popularization of day surgery in thoracic surgery. METHODS We retrospectively reviewed 86 patients underwent thoracic day surgery under the application of robot-assisted surgery system and through systematic randomization method choose 86 patients underwent conventional thoracic surgery under the application of robot-assisted surgery system at our Institute between 2020 and 2022. We analyzed the clinical and pathological features between the two groups. RESULTS The clinical feature of location of the nodules, the size of nodules, pN, histology and postoperative complications were homogenous between the two groups. The average age was significantly higher in the conventional mode group, the ratio of male patients and the patients with history of smoking were significantly lower in day-surgery mode group. The major surgical method in conventional mode group was lobectomy resection (48.8%). While the segmental resection was the major surgical in day surgery mode group. The hospital stay and the time of drain was significant longer in conventional mode group. And the total medical cost in conventional was more than day-surgery mode group. While the histology and postoperative complications were homogenous between the two groups. CONCLUSION Before this, day surgery and robotics assistant surgery in thoracic surgery had been proved feasibility and safety. However, there was no report of day surgery unit robotics assistant thoracic surgery. Our clinical practice demonstrated that the method of day surgery unit robotics thoracic surgery is feasibility and safety enough.
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Affiliation(s)
- Xin Li
- Department of Thoracic Surgery, XiangyaHospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Research Center for Pulmonary Nodules Precise Diagnosis & Treatment, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Changsha, 410008, Hunan, China
| | - Yuanqi Liu
- Department of Thoracic Surgery, XiangyaHospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Research Center for Pulmonary Nodules Precise Diagnosis & Treatment, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Changsha, 410008, Hunan, China
| | - Yanwu Zhou
- Department of Thoracic Surgery, XiangyaHospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Research Center for Pulmonary Nodules Precise Diagnosis & Treatment, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Changsha, 410008, Hunan, China
| | - Yang Gao
- Department of Thoracic Surgery, XiangyaHospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Research Center for Pulmonary Nodules Precise Diagnosis & Treatment, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Changsha, 410008, Hunan, China
| | - Chaojun Duan
- Department of Thoracic Surgery, XiangyaHospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Research Center for Pulmonary Nodules Precise Diagnosis & Treatment, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Changsha, 410008, Hunan, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, XiangyaHospital, Central South University, Changsha, 410008, Hunan, People's Republic of China.
- Hunan Engineering Research Center for Pulmonary Nodules Precise Diagnosis & Treatment, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Changsha, 410008, Hunan, China.
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Long-term Outcomes of Endoscopic Thoracoscopic Sympathectomy for Primary Focal Palmar Hyperhidrosis: High Patient Satisfaction Rates Despite Significant Compensatory Hyperhidrosis. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:730-735. [PMID: 36130719 DOI: 10.1097/sle.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Endoscopic thoracoscopic sympathectomy (ETS) is the gold standard therapy for primary focal palmar hyperhidrosis (PFPH), resulting in high patient satisfaction rates. The most common side effect of ETS is compensatory hyperhidrosis (CH). Previous studies followed patients' satisfaction degree of surgery and the incidence of CH during a limited follow-up period of 1 to 3 years. The purpose of this study was to investigate the long-term outcomes and patient satisfaction after ETS. MATERIALS AND METHODS After approval of our institutional review board, we conducted a retrospective review of all consecutive patients who underwent ETS for PFPH at our institution between 1998 and 2019. Electronic medical records were reviewed for short-term outcomes. Long-term outcomes were collected through telephone questionnaires. Primary outcome was the resolution of PFPH. Secondary outcomes were CH and long-term patient satisfaction. RESULTS During the study period, 256 patients underwent ETS to treat primary focal palmar hyperhidrosis at our institution between the years 1998-2019. One-hundred and fifty (58.6%) patients agreed to participate in the study and were included in the final analysis. The mean age was 23.8 (17 to 58) years, 56% were females. The mean follow-up time was 11±6.1 (1 to 22) years. Ninety-four percent reported resolution of PFPH; however, CH was reported by 90% of participants. CH decreased mean patient satisfaction score from 4.8±0.5 to 3.8±2 (P=0.009). This effect was more pronounced in patients with CH of the head and neck (P=0.009). Patients' satisfaction decreased over time from a mean of 4.8±0.4 in the first year after surgery to a mean of 3.7±1.4 12 years or more after surgery (P <0.001). Despite this, 79% of patients reported they would recommend ETS to other patients. CONCLUSIONS ETS for PFPH is highly effective and results in high patient satisfaction rates even after long-term follow-up. Despite high rates of postoperative CH, nearly 80% of patients would still recommend the procedure to fellow patients, justifying its reputation as the gold standard treatment for PFPH.
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Grott M, Eichhorn M, Eichhorn F, Schmidt W, Kreuter M, Winter H. Thoracic surgery in the non-intubated spontaneously breathing patient. Respir Res 2022; 23:379. [PMID: 36575519 PMCID: PMC9793515 DOI: 10.1186/s12931-022-02250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 11/12/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The interest in non-intubated video-assisted thoracic surgery (NIVATS) has risen over the last decade and numerous terms have been used to describe this technique. They all have in common, that the surgical procedure is performed in a spontaneously breathing patient under locoregional anaesthesia in combination with intravenous sedation but have also been performed on awake patients without sedation. Evidence has been generated favouring NIVATS compared to one-lung-ventilation under general anaesthesia. MAIN BODY We want to give an overview of how NIVATS is performed, and which different techniques are possible. We discuss advantages such as shorter length of hospital stay or (relative) contraindications like airway difficulties. Technical aspects, for instance intraoperative handling of the vagus nerve, are considered from a thoracic surgeon's point of view. Furthermore, special attention is paid to the cohort of patients with interstitial lung diseases, who seem to benefit from NIVATS due to the avoidance of positive pressure ventilation. Whenever a new technique is introduced, it must prove noninferiority to the state of the art. Under this aspect current literature on NIVATS for lung cancer surgery has been reviewed. CONCLUSION NIVATS technique may safely be applied to minor, moderate, and major thoracic procedures and is appropriate for a selected group of patients, especially in interstitial lung disease. However, prospective studies are urgently needed.
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Affiliation(s)
- Matthias Grott
- grid.5253.10000 0001 0328 4908Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany ,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Martin Eichhorn
- grid.5253.10000 0001 0328 4908Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany ,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Florian Eichhorn
- grid.5253.10000 0001 0328 4908Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany ,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Werner Schmidt
- grid.5253.10000 0001 0328 4908Department of Anaesthesiology and Intensive Care Medicine, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany
| | - Michael Kreuter
- Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Center for Interstitial and Rare Lung Diseases, Pneumology Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany
| | - Hauke Winter
- grid.5253.10000 0001 0328 4908Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany ,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
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Rib-oriented Thoracoscopic Sympathetic Surgery for Hyperhidrosis: Prospective Long-term Results and Quality of Life. Surg Laparosc Endosc Percutan Tech 2021; 31:307-312. [PMID: 33605681 DOI: 10.1097/sle.0000000000000925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal thoracoscopic sympathetic surgery for primary palmar and/or axillary hyperhidrosis (PPAH) is still unclear because of lack of uniform technique and qualitative/quantitative scales for definition of results. The aims of this study were to compare long-term outcomes based on the surgical technique and the level of sympathetic trunk interruption by clipping and to assess postoperative compensatory sweating (CS), patients' satisfaction, and quality of life (QoL). MATERIALS AND METHODS Between September 2009 and April 2016, 94 patients who underwent 2-stage bilateral thoracoscopic rib-oriented (R) sympathetic clipping were prospectively followed up through the administration of standardized preoperative and postoperative questionnaires.Thirty-four (36.2%) patients underwent single-port transaxillary access instead of the standard two 5-mm incisions. The level of sympathetic clipping for PPAH was R3+4(top and bottom); in patients who complained associated facial or plantar hyperhidrosis R2-bottom and R5-top were clipped, respectively. Seventy-five patients completed bilateral surgery. RESULTS There were no significant differences between single-port and biportal video-assisted thoracoscopic surgery in terms of operative times and postoperative results. At a mean follow-up of 72 (SD: 26) months, CS was reported in 42 (56%) patients, severe only in 6 (8%). It was higher in the case of R2-bottom clipping (P=0.03). Thirty-one of 60 (51.6%) patients who had a plantar hyperhidrosis declared an improvement of feet sweating after surgery. Postoperative satisfaction was excellent (86.11% on a 0 to 100 scale) and 95.4% of patients declared an improvement in QoL, which was statistically significant in all evaluated parameters. These results were not related to the level of clipping. CONCLUSION Thoracoscopic R3 to R4 clipping appears to be a safe and effective treatment for PPAH. Although postoperative CS was common and higher after R2-bottom clipping, this did not seem to affect patients' satisfaction and improvement in QoL.
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Vanni G, Materazzo M, Perretta T, Meucci R, Anemona L, Buonomo C, Dauri M, Granai AV, Rho M, Ingallinella S, Tacconi F, Ambrogi V, Chiaravalloti A, Schillaci O, Petrella G, Buonomo OC. Impact of Awake Breast Cancer Surgery on Postoperative Lymphocyte Responses. In Vivo 2020; 33:1879-1884. [PMID: 31662515 DOI: 10.21873/invivo.11681] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Surgical stress and anesthesia affect the patient's immune system. Analysis of the lymphocyte response after breast-conserving surgery was conducted to investigate the differences between effects after general and local anesthesia. MATERIALS AND METHODS Fifty-six patients with breast cancer were enrolled for BCS through local or general anesthesia. Total leukocytes, total lymphocytes, lymphocyte-subsets including CD3+, CD19+, CD4+, CD8+, CD16+CD56+ and CD4+/CD8+ ratio was examined at baseline and on postoperative days 1, 2 and 3. RESULTS Baseline data showed no statistical difference between the two groups. Within-group ANOVA test showed significant differences for total leukocyte count (p<0.001), total lymphocyte count (p=0.009) and proportion of natural-killer cells (p=0.01) in the control group. Between-group analysis showed lower median values of total lymphocytes in the awake surgery group on postoperative days 1, 2 and 3 (p=0.001, p=0.02 and p=0.01, respectively) when compared to the control group. Patients who underwent surgery under general anesthesia had higher total lymphocyte counts on postoperative day 2 (p=0.04). CONCLUSION In this randomized study, breast-conserving surgery plus local anesthesia had a lower impact on postoperative lymphocyte response when compared to the same procedure performed under general anesthesia.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Buonomo
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Rome, Italy
| | - Mario Dauri
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Rome, Italy
| | | | - Maurizio Rho
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Sara Ingallinella
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Federico Tacconi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Vincenzo Ambrogi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Giuseppe Petrella
- Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Gálvez C, Bolufer S, Gálvez E, Navarro-Martínez J, Galiana-Ivars M, Sesma J, Rivera-Cogollos MJ. Anatomic Segmentectomy in Nonintubated Video-Assisted Thoracoscopic Surgery. Thorac Surg Clin 2020; 30:61-72. [PMID: 31761285 DOI: 10.1016/j.thorsurg.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Thoracic surgery has evolved into minimally invasive surgery, in terms of not only surgical approach but also less aggressive anesthesia protocols and lung-sparing resections. Nonintubated anatomic segmentectomies are challenging procedures but can be safely performed if some essentials are considered. Strict selection criteria, previous experience in minor procedures, multidisciplinary cooperation, and the 4 cornerstones (deep sedation, regional analgesia, oxygenation support and vagal blockade) should be followed. Better outcomes in postoperative recovery, including resumption of oral intake, chest tube duration, and hospital stay, and low complication and conversion rates, are encouraging but should be checked in larger multicenter prospective randomized trials.
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Affiliation(s)
- Carlos Gálvez
- Thoracic Surgery Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain.
| | - Sergio Bolufer
- Thoracic Surgery Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - Elisa Gálvez
- Medical Oncology, Hospital General Universitario Elda, Ctra. Sax- La Torreta, S/N, Elda, Alicante 03600, Spain
| | - Jose Navarro-Martínez
- Anesthesiology and Surgical Critical Care Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - Maria Galiana-Ivars
- Anesthesiology and Surgical Critical Care Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - Julio Sesma
- Thoracic Surgery Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - María Jesús Rivera-Cogollos
- Anesthesiology and Surgical Critical Care Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
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Elia S, Loprete S, De Stefano A, Hardavella G. Does aggressive management of solitary pulmonary nodules pay off? Breathe (Sheff) 2019; 15:15-23. [PMID: 30838056 PMCID: PMC6395991 DOI: 10.1183/20734735.0275-2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Indeterminate solitary pulmonary nodules (SPNs), measuring up to 3 cm in diameter, are incidental radiological findings. The ever-growing use of modern imaging has increased their detection. The majority of those nodules are benign; however, the possibility of diagnosing early-stage lung cancer still stands. Guidelines for the management of SPNs have never been validated in prospective comparative studies. Positron emission tomography (PET) is a useful tool to provide functional information on SPNs. However, overall sensitivity and specificity of PET in detecting malignant SPNs of at least 10 mm in diameter are about 90% and false-negative results are reported. The development of video-assisted thoracic surgery has provided minimally invasive diagnosis and treatment of SPNs. In our series, 105 patients underwent surgery based on combined increased 18F-labelled 2-fluoro-2-deoxy-d-glucose (FDG) uptake on PET computed tomography and radiological features (morphology and density) without prior histological confirmation. We detected 26 false negatives (24.8%) and only nine false positives (8.57%). Therefore, our minimally invasive surgical approach prevented 25% of patients with lung cancer from a delayed treatment versus only 9% undergoing “overtreatment”. In our monocentric cohort, patients with SPNs with large diameter, irregular outline, no calcifications, central location, increased FDG uptake and/or subsolid aspect benefited from a primary surgical resection. There is much debate on the best management of solitary pulmonary nodules. Even if they are mostly benign, they may represent an early-stage lung cancer. Minimally invasive surgical removal is probably the best approach to this insidious disease.http://ow.ly/wMKz30nemjR
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Affiliation(s)
- Stefano Elia
- Dept of Surgical Sciences, Thoracic Surgery Unit, Tor Vergata University, Rome, Italy
| | - Serafina Loprete
- Dept of Biomedicine and prevention, Tor Vergata University, Rome, Italy
| | | | - Georgia Hardavella
- Dept of Respiratory Medicine and Allergy, Medical School, King's College London, London, UK.,10th Dept of Respiratory Medicine, Athens' Chest Diseases Hospital "Sotiria", Athens, Greece
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Wade R, Rice S, Llewellyn A, Moloney E, Jones-Diette J, Stoniute J, Wright K, Layton AM, Levell NJ, Stansby G, Craig D, Woolacott N. Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis. Health Technol Assess 2019; 21:1-280. [PMID: 29271741 DOI: 10.3310/hta21800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. OBJECTIVE To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. METHODS A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. RESULTS AND CONCLUSIONS Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. LIMITATIONS The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. FUTURE WORK Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses. STUDY REGISTRATION This study is registered as PROSPERO CRD42015027803. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Ros Wade
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Rice
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Alexis Llewellyn
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Eoin Moloney
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Julija Stoniute
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Nick J Levell
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Gerard Stansby
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
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Abstract
PURPOSE OF REVIEW This review focuses primarily on nonintubated video-assisted thoracic surgery (NIVATS), and discusses advantages, indications, anesthetic techniques, and approaches to intraoperative crisis management. RECENT FINDINGS Advancements in endoscopic, endovascular, and robotic techniques have expanded the range of surgical procedures that can be performed in a minimally invasive fashion. For thoracic operations in particular, video-assisted thoracic surgery (VATS) has largely replaced traditional thoracotomy, and continued technical development has made surgical access into the pleural space even less disruptive. As a consequence, the need for general anesthesia and endotracheal intubation has been re-examined, such that regional or epidural analgesia may be sufficient for cases where lung collapse can be accomplished with spontaneous ventilation and an open hemithorax. This concept of NIVATS has gained popularity, and in some centers has now expanded to include procedures involving placement of multiple ports. Although still relatively uncommon at present, a small number of randomized trials and meta-analyses have indicated some advantages, suggesting that NIVATS may be a desirable alternative to general anesthesia with endotracheal intubation for specific indications. SUMMARY Although anesthesia for NIVATS is associated with some of the same risks as general anesthesia with endotracheal intubation, NIVATS can be successfully performed in carefully selected patients.
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10
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Migliore M, Palazzolo M, Pennisi M, Nardini M, Borrata F. Extended uniportal bilateral sympathectomy. J Vis Surg 2018; 4:27. [PMID: 29445613 DOI: 10.21037/jovs.2017.09.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 11/06/2022]
Abstract
Hyperhidrosis affect 3% of the population and, despite benign nature of the disease, the individuals seek medical advice in order to improve their quality of life which can be severely compromised. The interruption of the sympathetic chain (sympathectomy) and of the nerve of Kuntz established its role as the definitive treatment of primary hyperhidrosis. In this manuscript, we present our extended uniportal technique with the aid of the video. Uniportal approach expresses all its benefit when applied for this procedure because there is no specimen to be retrieved and all the surgery is accomplished through a 1-2 cm port access.
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of General and Medical Specialties, Policlinico University Hospital of Catania, University of Catania, Catania, Italy
| | - Manuela Palazzolo
- Section of Thoracic Surgery, Department of General and Medical Specialties, Policlinico University Hospital of Catania, University of Catania, Catania, Italy
| | - Manuela Pennisi
- Section of Thoracic Surgery, Department of General and Medical Specialties, Policlinico University Hospital of Catania, University of Catania, Catania, Italy
| | - Marco Nardini
- Section of Thoracic Surgery, Department of General and Medical Specialties, Policlinico University Hospital of Catania, University of Catania, Catania, Italy
| | - Francesco Borrata
- Section of Thoracic Surgery, Department of General and Medical Specialties, Policlinico University Hospital of Catania, University of Catania, Catania, Italy
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11
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Katlic MR. Five Hundred Seventy-Six Cases of Video-Assisted Thoracic Surgery Using Local Anesthesia and Sedation: Lessons Learned. J Am Coll Surg 2018; 226:58-63. [DOI: 10.1016/j.jamcollsurg.2017.09.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/23/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
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Sang HW, Li GL, Xiong P, Zhu MC, Zhu M. Optimal targeting of sympathetic chain levels for treatment of palmar hyperhidrosis: an updated systematic review. Surg Endosc 2017; 31:4357-4369. [PMID: 28389800 DOI: 10.1007/s00464-017-5508-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/08/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Palmar hyperhidrosis involves excessive sweating of the palms, with no known etiology. Endoscopic thoracic sympathectomy (ETS) is a safe and effective treatment for palmar hyperhidrosis, but compensatory hyperhidrosis is a common complication after ETS, leading to reduced patient satisfaction and postoperative quality of life. However, the appropriate level of the sympathetic chain to target with ETS to achieve maximum efficacy and reduce the risk of compensatory hyperhidrosis (CH) is controversial. In this systemic review, we investigated the appropriate level of sympathectomy for palmar hyperhidrosis. METHODS PRISMA guidelines were implemented to complete a systematic review. We performed a computerized systematic literature search using PubMed and EMBASE from January 1990 to July 2016. We chose the Cochrane Collaboration's tool and the methodological index for non-randomized studies tool for examining study bias. RESULTS A total of 4075 citations were identified, of which 91 were eligible for inclusion, including 68 observational studies and 23 comparative trials. In observational studies, sympathectomies showed similar efficacies for curing PH at different levels. However, T2-free groups (i.e., at levels T3, T4, or T3-T4 combined) could render a lower risk of Horner's syndrome (0 vs. 1.21 ± 0.49%, p = 0.036) and CH (28.75 ± 7.25 vs. 57.46 ± 3.86, p = 0.002) compared with T2 involved. In comparative trials, there were 12 studies describing the comparison between T2-free ETS and T2 involved, and 9 of 12 (75%) showed T2-free ETS could reduce the incidence of CH. Overall, lowering the level and limiting the extent of sympathectomy could reduce the incidence of complications. CONCLUSIONS Cumulative data from more than 13,000 patients suggest that ETS is a safe, effective, and reproducible procedure with a high degree of patient satisfaction. Currently available evidence suggests that T2-free ETS may reduce the incidence of compensatory hyperhidrosis without compromising success rates and safety.
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Affiliation(s)
- Hai-Wei Sang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China.,Department of Thoracic Surgery, First Affiliated Hospital of Bengbu Medical College, 287 Chang Huai Road, Bengbu, 233004, Anhui, China
| | - Guo-Liang Li
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Peng Xiong
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Ming-Chuang Zhu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Min Zhu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China.
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de Campos JRM, da Fonseca HVS, Wolosker N. Quality of Life Changes Following Surgery for Hyperhidrosis. Thorac Surg Clin 2016; 26:435-443. [PMID: 27692202 DOI: 10.1016/j.thorsurg.2016.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The best way to evaluate the impact of primary hyperhidrosis on quality of life (QL) is through specific questionnaires, avoiding generic models that do not appropriately evaluate individuals. QL improves significantly in the short term after sympathectomy. In the longer term, a sustained and stable improvement is seen, although there is a small decline in the numbers; after 5 and even at 10 years of follow-up it shows virtually the same numerical distribution. Compensatory hyperhidrosis is a major side effect and the main aggravating factor in postoperative QL, requiring attention to its management and prevention.
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Affiliation(s)
- José Ribas Milanez de Campos
- Thoracic Surgery Division, Heart Institute/Clinics Hospital from University of São Paulo Medical School, 44 Dr. Enéas de Carvalho Aguiar Av., São Paulo 05403-000, São Paulo, Brazil
| | - Hugo Veiga Sampaio da Fonseca
- Thoracic Surgery Division, Heart Institute/Clinics Hospital from University of São Paulo Medical School, 44 Dr. Enéas de Carvalho Aguiar Av., São Paulo 05403-000, São Paulo, Brazil.
| | - Nelson Wolosker
- Vascular Surgery Division, Albert Einstein Israelite Hospital, 627/701 Albert Einstein Avenue, Block A1, Room 423, Morumbi, São Paulo 05652-900, São Paulo, Brazil; Vascular and Endovascular Division, Clinics Hospital from University of São Paulo Medical School, 225 Dr Ovídio Pires Campos St, Ambulatory Building, 6th floor, Unit 7B, São Paulo 05403-010, São Paulo, Brazil
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Dai X, Song P, Zhang B. [Application of Non-intubated Anesthesia in VATS]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:312-6. [PMID: 27215461 PMCID: PMC5973052 DOI: 10.3779/j.issn.1009-3419.2016.05.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
气管插管全麻技术可提高手术安全性,因此在电视胸腔镜手术(video-assisted thoracic surgery, VATS)中得到广泛应用,但气管插管的并发症却无法避免。如何发展一种“整体微创”手术(包括麻醉微损伤),已经成为微创胸外科领域的一个研究热点。随着麻醉管理技术与对手术风险管理的进步,非气管插管技术成功应用于VATS,即采用局部麻醉以维持患者的术中自主通气,术中仅需轻微镇静或者完全清醒的状态下实施VATS,因而又称清醒状态下VATS。此麻醉方式不但减少气管插管的麻醉损伤,而且符合快速康复外科的理念。本文对非气管插管应用在胸外科VATS中的发展简史、麻醉选择、手术优势、手术风险及管理、面临的问题等方面作一综述。
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Affiliation(s)
- Xiaotan Dai
- School of Medicine and Life Sclences, University of Jinan, Jinan 250117, China
| | - Pingping Song
- School of Medicine and Life Sclences, University of Jinan, Jinan 250117, China
| | - Baijiang Zhang
- Shandong Academy of Medical Sciences, Jinan 250117, China
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Tacconi F, Pompeo E. Non-intubated video-assisted thoracic surgery: where does evidence stand? J Thorac Dis 2016; 8:S364-75. [PMID: 27195134 DOI: 10.21037/jtd.2016.04.39] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In recent years, non-intubated video-assisted thoracic surgery (NIVATS) strategies are gaining popularity worldwide. The main goal of this surgical practice is to achieve an overall improvement of patients' management and outcome thanks to the avoidance of side-effects related to general anesthesia (GA) and one-lung ventilation. The spectrum of expected benefits is multifaceted and includes reduced postoperative morbidity, faster discharge, decreased hospital costs and a globally reduced perturbation of patients' well-being status. We have conducted a literature search to evaluate the available evidence on this topic. Meta-analysis of collected results was also done where appropriate. Despite some fragmentation of data and potential biases, the available data suggest that NIVATS operations can reduce operative morbidity and hospital stay when compared to equipollent procedures performed under GA. Larger, well designed prospective studies are thus warranted to assess the effectiveness of NIVATS as far as to investigate comprehensively the various outcomes. Multi-institutional and multidisciplinary cooperation will be welcome to establish uniform study protocols and to help address the questions that are to be answered yet.
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Affiliation(s)
- Federico Tacconi
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
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Obeso Carillo GA, Cañizares Carretero MÁ, Padín Barreiro L, Soro García J, Blanco Tuimil L. Nonintubated bilateral single port thoracoscopic sympathectomy in the context of an outpatient program, the least invasive management for hyperhidrosis surgery. ANNALS OF TRANSLATIONAL MEDICINE 2016; 3:357. [PMID: 26807412 DOI: 10.3978/j.issn.2305-5839.2015.12.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Primary hyperhidrosis is a frequent dysfunctional disorder characterized by excessive sweating in amounts greater than required for physiological needs. Surgery remains the mainstay of treatment when there is no response to medical therapies. Traditionally, thoracoscopic sympathectomy is performed routinely by means of general anesthesia with endotracheal intubation. Here we report the least invasive management for hyperhidrosis surgery, a nonintubated bilateral single port thoracoscopic sympathectomy in the context of an outpatient program.
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Affiliation(s)
- Gerardo Andrés Obeso Carillo
- 1 Department of Thoracic Surgery, La Princesa University Clinical Hospital, Madrid, Spain ; 2 Department of Thoracic Surgery, 3 Department of Anesthesiology, Vigo University Clinical Hospital, Vigo, Spain
| | - Miguel Ángel Cañizares Carretero
- 1 Department of Thoracic Surgery, La Princesa University Clinical Hospital, Madrid, Spain ; 2 Department of Thoracic Surgery, 3 Department of Anesthesiology, Vigo University Clinical Hospital, Vigo, Spain
| | - Lidia Padín Barreiro
- 1 Department of Thoracic Surgery, La Princesa University Clinical Hospital, Madrid, Spain ; 2 Department of Thoracic Surgery, 3 Department of Anesthesiology, Vigo University Clinical Hospital, Vigo, Spain
| | - Jose Soro García
- 1 Department of Thoracic Surgery, La Princesa University Clinical Hospital, Madrid, Spain ; 2 Department of Thoracic Surgery, 3 Department of Anesthesiology, Vigo University Clinical Hospital, Vigo, Spain
| | - Luisa Blanco Tuimil
- 1 Department of Thoracic Surgery, La Princesa University Clinical Hospital, Madrid, Spain ; 2 Department of Thoracic Surgery, 3 Department of Anesthesiology, Vigo University Clinical Hospital, Vigo, Spain
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Gonzalez-Rivas D, Bonome C, Fieira E, Aymerich H, Fernandez R, Delgado M, Mendez L, de la Torre M. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg 2015; 49:721-31. [DOI: 10.1093/ejcts/ezv136] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/09/2015] [Indexed: 01/07/2023] Open
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Kuhajda I, Djuric D, Milos K, Bijelovic M, Milosevic M, Ilincic D, Ilic M, Koledin B, Kuhajda D, Tsakiridis K, Mpakas A, Zarogoulidis K, Kioumis I, Lampaki S, Zarogoulidis P, Komarcevic M. Semi-Fowler vs. lateral decubitus position for thoracoscopic sympathectomy in treatment of primary focal hyperhidrosis. J Thorac Dis 2015; 7:S5-S11. [PMID: 25774308 DOI: 10.3978/j.issn.2072-1439.2015.01.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/30/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study is to compare usefulness of Semi-Fowler position vs. lateral decubitus position for thoracoscopic sympathectomy in treatment of primary focal hyperhidrosis. MATERIALS AND METHODS From January 2009 to January 2010, 263 consecutive patients with palmar and axillar hyperhidrosis underwent thoracoscopic sympathectomy Th2-Th4. Patients were divided into two groups: group A (n=133) underwent thoracoscopic sympathectomy through lateral decubitus using double lumen endotracheal intubation, and group B (n=130) underwent thoracoscopic sympathectomy through Semi-Fowler supine position (semi sitting with arm abducted) using single lumen endotracheal intubation without insufflation of CO2, but with short apnea period. All operations were performed through two 5 mm operating ports, videothoracoscopic camera 0° and endoscopic ultrasound activated harmonic scalpel. RESULTS There were 107 males and 156 females with median age 30.31±8.35 years. Two groups were comparable in gender, age, severity of sweating. All operations were successfully performed with no complications or perioperative morbidity. For group A average operation time for both sides was 31.2±3.87 min and for group B average time was 14.19±4.98 min. In group B apnea period per one lung lasts 2.86±1.15 min and during that period observed saturation was 92.65%±5.66% without significant cardiorespiratory disturbances. Pleural drains were taken off on operation table after forced manually lung reexpansion. Patients were discharged from hospital for few hours, after the operation and radiologic confirmation of complete lung reexpansion. CONCLUSIONS Based on this data (shorter operating time, lack of incomplete lung collapse, insignificant apnea and better reexpansion of lungs) we concluded that thoracoscopic sympathectomy through Semi-Fowler supine position is highly effective and easy to perform for primary hyperhidrosis.
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Affiliation(s)
- Ivan Kuhajda
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Dejan Djuric
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Koledin Milos
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Milorad Bijelovic
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Misel Milosevic
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Dejan Ilincic
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Miroslav Ilic
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Bojan Koledin
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Danijela Kuhajda
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Kosmas Tsakiridis
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Andreas Mpakas
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Konstantinos Zarogoulidis
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Ioannis Kioumis
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Sofia Lampaki
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Paul Zarogoulidis
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Milana Komarcevic
- 1 Thoracic Surgery Department, Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, 2 Department of Medical Rehabilitation, University of Novi Sad, Novi Sad, Serbia; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 4 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Department of Anesthesia and Intensive Care, Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
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Hung MH, Hsu HH, Cheng YJ, Chen JS. Nonintubated thoracoscopic surgery: state of the art and future directions. J Thorac Dis 2014; 6:2-9. [PMID: 24455169 DOI: 10.3978/j.issn.2072-1439.2014.01.16] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 01/13/2014] [Indexed: 12/19/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) has become a common and globally accepted surgical approach for a variety of thoracic diseases. Conventionally, it is performed under tracheal intubation with double lumen tube or bronchial blocker to achieve single lung ventilation. Recently, VATS without tracheal intubation were reported to be feasible and safe in a series of VATS procedures, including management of pneumothorax, wedge resection of pulmonary tumors, excision of mediastinal tumors, lung volume reduction surgery, segmentectomy, and lobectomy. Patients undergoing nonintubated VATS are anesthetized using regional anesthesia in a spontaneously single lung breathing status after iatrogenic open pneumothorax. Conscious sedation is usually necessary for longer and intensively manipulating procedures and intraoperative cough reflex can be effectively inhibited with intrathoracic vagal blockade on the surgical side. The early outcomes of nonintubated VATS include a faster postoperative recovery and less complication rate comparing with its counterpart of intubated general anesthesia, by which may translate into a fast track VATS program. The future directions of nonintubated VATS should focus on its long-term outcomes, especially on oncological perspectives of survival in lung cancer patients. For now, it is still early to conclude the benefits of this technique, however, an educating and training program may be needed to enable both thoracic surgeons and anesthesiologists providing an alternative surgical option in their caring patients.
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Affiliation(s)
- Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan ; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan ; Division of Experimental Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Tang H, Wu B, Xu Z, Xue L, Li B, Zhao X. A new surgical procedure for palmar hyperhidrosis: is it possible to perform endoscopic sympathectomy under deep sedation without intubation? Eur J Cardiothorac Surg 2014; 46:286-90; discussion 290. [DOI: 10.1093/ejcts/ezt599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
There has been an exciting expansion in the practice of medical pleuroscopy in recent years. As technology has become more available and confidence in the use of equipment has grown, medical thoracoscopy has become a core diagnostic and therapeutic tool in pleural disease care. Despite this, many areas of medical pleuroscopy practice remain conspicuously devoid of well-established evidence. More knowledge is needed in those areas where there is currently a degree of equipoise. Many areas where pleuroscopy currently has a marginal role require high-quality randomized trials be undertaken with a view to informing future practice and guidelines.
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Affiliation(s)
- Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Level 2, Learning and Research Building, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK
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Pompeo E. Awake Thoracic Surgery— Is it Worth the Trouble? Semin Thorac Cardiovasc Surg 2012; 24:106-14. [DOI: 10.1053/j.semtcvs.2012.06.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2012] [Indexed: 11/11/2022]
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Day surgery unit thoracic surgery: the first UK experience. Eur J Cardiothorac Surg 2011; 39:1047-50. [DOI: 10.1016/j.ejcts.2010.09.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 09/15/2010] [Accepted: 09/22/2010] [Indexed: 11/22/2022] Open
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Tejedor A, Anglada MT, Pons M, Callejas MA, Gomar C. [Outpatient or short-stay videothoracoscopy-assisted thoracic sympathectomy: anesthesia in 445 cases]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:553-558. [PMID: 21155335 DOI: 10.1016/s0034-9356(10)70281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To demonstrate the safety of outpatient or short-stay bilateral videothoracoscopy-assisted thoracic sympathectomy. PATIENTS AND METHODS The medical records of 445 who underwent bilateral videothoracoscopy-assisted thoracic sympathectomy were reviewed; the same protocols were used to guide these outpatient or short-stay procedures in all cases. Intravenous anesthesia was provided. An orotracheal tube allowed for carrying out the sympathectomy procedure during short periods of apnea. A 2% lidocaine solution was infused through the thoracic drains, which were removed soon after surgery. Data on intraoperative respiratory variables, pain, and intra- and postoperative complications were gathered. The data for patients undergoing the procedure on an outpatient or short-stay basis were compared. RESULTS No significant differences in demographic or perioperative variables were found between the 2 groups. In 3.6% of the patients in the series, there was a record of a postoperative pulmonary complication: 4 therapeutic minithoracotomies; 1 subcutaneous emphysema without radiologic changes; 9 residual pneumothoraces, 2 requiring pleural drainage; 1 chylothorax; and 1 delayed hemothorax. With the exception of the late-developing hemothorax, all complications were diagnosed and treated in the immediate postoperative period. In the outpatient surgery group, unplanned admissions because of patient refusal to leave occurred in 6.5% of the cases. CONCLUSION The low incidence of complications, and especially the finding that complications are detected in the early recovery period, indicate that this procedure can be performed on an outpatient basis.
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Affiliation(s)
- A Tejedor
- Servicio de Anestesiología y Reanimación, Hospital Clínic, Universidad de Barcelona.
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Katlic MR, Facktor MA. Video-Assisted Thoracic Surgery Utilizing Local Anesthesia and Sedation: 384 Consecutive Cases. Ann Thorac Surg 2010; 90:240-5. [DOI: 10.1016/j.athoracsur.2010.02.113] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 02/22/2010] [Accepted: 02/24/2010] [Indexed: 11/28/2022]
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Herke L, Vincze K, Matkó I. [One-stage bilateral vats-sympathectomy for the treatment of severe upper body hyperhidrosis]. Magy Seb 2010; 63:30-2. [PMID: 20156792 DOI: 10.1556/maseb.63.2010.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Thoracoscopic sympathectomy (VATS) is routinely used to treat severe palmar and axillary hyperhydrosis. The authors present a novel method: one-stage bilateral VATS-sympathectomy. Special considerations also discussed regarding the anaesthesia and operative technique of the procedure. The history of surgical therapy of hyperhidrosis is reviewed briefly, too. The authors conclude that one-stage bilateral VATS-sympathectomy for palmar and axillary severe hyperhidrosis is a safe and effective method, patient satisfaction improves and cost is significantly decreased due to shorter hospital stay.
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Affiliation(s)
- László Herke
- Kaposi Mór Oktató Kórház, Altalános Sebészeti-, Er- és Mellkas Sebészeti Osztály, 7400 Kaposvár, Bajcsy-Zs. u. 90.
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Awad MS, Elzeftawy A, Mansour S, Elshelfa W. One stage bilateral endoscopic sympathectomy under local anesthesia: Is a valid, and safe procedure for treatment of palmer hyperhidrosis? J Minim Access Surg 2010; 6:11-5. [PMID: 20585488 PMCID: PMC2883825 DOI: 10.4103/0972-9941.62529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 01/28/2010] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Thoracoscopic sympathetic surgery is currently the best treatment for hyperhidrosis, and the success rate is quite high, but poor emphasis has been given to the type of anaesthesia and its application through either one or two stages of surgery. This study has evaluated the operative and postoperative results of one-stage bilateral thoracoscopic sympathectomy under local anaesthesia. MATERIALS AND METHODS From 2003 to 2007, n=14 patients with hyperhidrosis of the upper limbs [4 females and 10 males] with a mean age of 28+/-2.11 year [range 26-44] were included. They were operated on by means of bilateral ETS under local anaesthesia. The mean follow-up was 1.5 years (range 13-24 months). RESULTS No operative mortality was recorded. The mean operating room time for the whole bilateral procedure under was 73. 5+/-14.5 range [60 -120] min most of the patients were discharged the same day after a chest roentgenogram except, only two patients with gustatory sweating one recurrent sweating in the patient who had previously axillary hyperhidrosis. Also among them two patients (20%) experienced a minimal pneumothorax that required no treatment. Postoperative quality of life and satisfaction were excellent and cost was significantly reduced. CONCLUSIONS Bilateral thoracoscopic sympathectomy for palmar hyperhidrosis could be safely and effectively performed in patients refusing GA regarding cost and satisfaction.
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Affiliation(s)
- Mohamed Salah Awad
- Department of Surgery, Zagazig University Hospital, General Surgery Department, Egypt
| | - Awny Elzeftawy
- Department of Surgery, Zagazig University Hospital, General Surgery Department, Egypt
| | - Salah Mansour
- Department of Surgery, Zagazig University Hospital, General Surgery Department, Egypt
| | - Wael Elshelfa
- Department of Surgery, Zagazig University Hospital, General Surgery Department, Egypt
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Vincze K, Herke L, Ferenczy J, Seffer I, Lelovics Z. [Therapeutic modalities in the treatment of palmar and axillary hyperhidrosis]. Orv Hetil 2009; 150:1786-90. [PMID: 19740724 DOI: 10.1556/oh.2009.28618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors summarize their therapeutic methods of palmar and axillary hyperhidrosis in this article. They discuss the characteristics, frequency of upper limb and patho-anatomical features of chronic sweating. Authors summarized their almost 40 years experience in treatment methods, technological improvements as well as they review recent knowledge and relevant literature. The open thoracotomic desympathization applied in the beginnings was gradually replaced by a minimally invasive VATS-sympathectomy (Video Assisted Thoracoscopic Surgery). The possibilities of conservative treatments, local excision methods will also be discussed, as well as the application and efficiency of Botox-treatments that are used in plastic surgery. The mean frequency of 0.1-1.0% described in scientific literature is indicative of a significant number of unresolved cases, which thus requires more efficient diagnostic and patient orientation practices. Based on their experiences, the most efficient treatment of upper limb hyperhidrosis is the thoracic sympathectomy (ramicotomy and the relevant T(2) -T(3) ganglia) according to Smithwick-procedure and modified by others. If necessary, one-stage bilateral VATS-surgery may be applied. Another effective conservative possibility is the Botox-therapy, which they had applied individually at the plastic surgery clinic. Significant complications or compensatory hyperhidrosis were not detected.
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Affiliation(s)
- Károly Vincze
- Kaposi Mór Oktató Megyei Kórház, Altalános Sebészeti, Er- és Mellkassebészeti Osztály, Kaposvár
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Ambrogi V, Campione E, Mineo D, Paternò EJ, Pompeo E, Mineo TC. Bilateral thoracoscopic T2 to T3 sympathectomy versus botulinum injection in palmar hyperhidrosis. Ann Thorac Surg 2009; 88:238-45. [PMID: 19559233 DOI: 10.1016/j.athoracsur.2009.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 03/31/2009] [Accepted: 04/01/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bilateral T2 to T3 thoracoscopic sympathectomy and injection of botulinum toxin-A are presently the most effective modalities in the treatment of primary palmar hyperhidrosis. In this study we evaluated comparative merits of the two therapies. METHODS Patients suffering primary palmar hyperhidrosis were treated by either bilateral T2 to T3 thoracoscopic sympathectomy (n = 68) or by injection of botulinum toxin-A (n = 86). The groups were homogeneous for relevant demographic, physiologic, and clinical data. Quantification of sweat production was performed by Minor's iodine starch and glove tests. Subjective changes were assessed by quality of life questionnaires (Hyperhidrosis, Dermatology Life Quality Index, Short Form-36, Nottingham's Health Profile) and patient's satisfaction self-assessment. A cost comparison between groups was also carried out. RESULTS No operative mortality or major morbidity was recorded in either group. Minor's test showed a more significant reduction in the surgical group: +94% versus +63% at 6 months and +94% versus +30% at 12 months. Compensatory sweating was significantly greater and long-lasting in the surgical group. All subjective tests improved rapidly and significantly in both groups. After 6 months, results mildly worsened in the surgical group and more significantly in the botulinum group. Patient's satisfaction was initially greater in the botulinum group (p = 0.03), but after 6 months it significantly reversed (p = 0.04). Surgical treatment cost approximately as much as four botulinum treatments. CONCLUSIONS Thoracoscopic sympathectomy is superior to botulinum toxin-A injection. The greater initial costs and discomfort are offset by a greater reduction in compensatory sweating.
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Affiliation(s)
- Vincenzo Ambrogi
- Division of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
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Outpatient videothoracoscopic sympathectomy: analgesia and complications. Eur J Anaesthesiol 2009; 26:348-50. [PMID: 19401669 DOI: 10.1097/eja.0b013e32831bd88e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kopelman D, Hashmonai M. The correlation between the method of sympathetic ablation for palmar hyperhidrosis and the occurrence of compensatory hyperhidrosis: a review. World J Surg 2009; 32:2343-56. [PMID: 18797962 DOI: 10.1007/s00268-008-9716-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Upper dorsal sympathectomy achieves excellent long-term results in the treatment of primary palmar hyperhidrosis. Compensatory hyperhidrosis (CHH) remains an unexplained sequel of this treatment, attaining in a small percentage of cases disastrous proportions. It has been claimed that lowering the level of sympathectomy (from T2 to T3 and even T4), substituting resection by other means of ablation, and limiting its extend reduce the occurrence of this sequel. This review was designed to evaluate the validity of these claims. METHODS A MEDLINE search was performed for the years 1990--2006 and all publications about thoracoscopic upper dorsal sympathectomy for hyperhidrosis were retrieved. RESULTS The search identified 42 techniques of sympathetic ablation. However, pertinent data for the present study were reported for only 23 techniques with multiple publications found only for 10. The only statistically valid results from this review point that T2 resection and R2 transection of the chain (over the second rib) ensue in less CHH than does electrocoagulation of T2. Further comparisons were probably prevented due to the enormous disparity in the reported results, indicating lack of standardization in definitions. CONCLUSIONS The compiled results published so far in the literature do not support the claims that lowering the level of sympathetic ablation, using a method of ablation other than resection, or restricting the extend of sympathetic ablation for primary palmar hyperhidrosis result in less CHH. In the future, standardization of the methods of retrieving and reporting data are necessary to allow such a comparison of data.
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Affiliation(s)
- Doron Kopelman
- Department of Surgery B, Ha'emek Hospital, Afula, Israel
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Henteleff HJ, Kalavrouziotis D. Evidence-based review of the surgical management of hyperhidrosis. Thorac Surg Clin 2008; 18:209-16. [PMID: 18557593 DOI: 10.1016/j.thorsurg.2008.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The great majority of the currently available evidence supporting sympathectomy for primary hyperhidrosis is observational, coming from a variety of prospective and restrospective clinical series as well as comparative studies. A cumulative experience in over 6000 patients suggests that ETS is a safe, reproducible, and effective procedure, and most patients are satisfied with the results of the surgery. The currently available experimental data comes from clinical trials that compared alternative levels of sympathetic chain disruption; these trials speak only to the relative merits of one surgical technique over another and do not provide an assessment of the overall impact of surgery in the general population of patients with primary hyperhidrosis. Furthermore, it is difficult to compare series and generalizability is compromised by a lack of uniform definitions and measures at both the exposure and outcome levels. There is marked heterogeneity with respect to study population and entry criteria, with significant variability of site and severity of excess sweating as well as the degree of preoperative conservative management of hyperhidrosis before surgical referral. Also the operative approach varies widely among studies, and the optimal procedure remains elusive: unilateral versus staged nonsimultaneous bilateral versus concomitant bilateral sympathectomy; ganglionic resection versus ablation using electrocoagulation or harmonic scalpel; clipping of the chain to maintain reversibility in the event of intolerable symptoms versus permanent disruption. In addition, the lack of uniform outcome measures makes these data difficult to interpret, and standardized metrics of surgical results are necessary, such as objective quantification of sweating by gravimetry or use of the SF-36 Health Survey Questionnaire as an estimate of patient quality of life. A multicenter, adequately powered, randomized controlled trial comparing surgical to medical management of hyperhidrosis is unlikely given the current enthusiasm for same-day thoracoscopic sympathectomy among surgeons, a largely positive literature replete with encouraging results, and well-informed hyperhidrosis patients who want to be cured of a socially debilitating illness. Future clinical trials in this area will likely compare surgical techniques. For such comparisons, procedures must be standardized and outcome measures validated for both symptoms of the disease and surgical complications. Finally, the studies must have large numbers of patients and adequate long-term follow-up if they are to detect differences in results among procedures with very high technical success rates.
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Affiliation(s)
- Harry J Henteleff
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
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Dexter F, Dexter EU, Masursky D, Nussmeier NA. Systematic review of general thoracic surgery articles to identify predictors of operating room case durations. Anesth Analg 2008; 106:1232-41, table of contents. [PMID: 18349199 DOI: 10.1213/ane.0b013e318164f0d5] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous studies of operating room (OR) information systems data over the past two decades have shown how to predict case durations using the combination of scheduled procedure(s), individual surgeon and assistant(s), and type of anesthetic(s). We hypothesized that the accuracy of case duration prediction could be improved by the use of other electronic medical record data (e.g., patient weight or surgeon notes using standardized vocabularies). METHODS General thoracic surgery was used as a model specialty because much of its workload is elective (scheduled) and many of its cases are long. PubMed was searched for thoracic surgery papers reporting operative time, surgical time, etc. The systematic literature review identified 48 papers reporting statistically significant differences in perioperative times. RESULTS There were multiple reports of differences in OR times based on the procedure(s), perioperative team including primary surgeon, and type of anesthetic, in that sequence of importance. All such detail may not be known when the case is originally scheduled and thus may require an updated duration the day before surgery. Although the use of these categorical data from OR systems can result in few historical data for estimating each case's duration, bias and imprecision of case duration estimates are unlikely to be affected. There was a report of a difference in case duration based on additional information. However, the incidence of the procedure for the diagnosis was so uncommon as to be unlikely to affect OR management. CONCLUSIONS Matching findings of prior studies using OR information system data, multiple case series show that it is important to rely on the precise procedure(s), surgical team, and type of anesthetic when estimating case durations. OR information systems need to incorporate the statistical methods designed for small numbers of prior surgical cases. Future research should focus on the most effective methods to update the prediction of each case's duration as these data become available. The case series did not reveal additional data which could be cost-effectively integrated with OR information systems data to improve the accuracy of predicted durations for general thoracic surgery cases.
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Affiliation(s)
- Franklin Dexter
- Department of Anesthesia, University of Iowa, Iowa City, IA 52242, USA.
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Lima AGD, Marcondes GA, Teixeira AB, Toro IFC, Campos JRMD, Jatene FB. Incidência de pneumotórax residual após simpatectomia torácica videotoracoscópica com e sem drenagem pleural e sua possível influência na dor pós-operatória. J Bras Pneumol 2008; 34:136-42. [DOI: 10.1590/s1806-37132008000300003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 06/26/2007] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar se o pneumotórax residual após simpatectomia torácica videotoracoscópica tem incidência diferente quando utilizada a drenagem pleural pós-operatória ou não e se este pneumotórax residual, quando presente, pode influenciar a dor pós-operatória até o 28º dia. MÉTODOS: Foram incluídos todos os pacientes com queixa de hiperidrose palmoplantar primária atendidos no Ambulatório de Cirurgia Torácica do Hospital Estadual Sumaré, de julho a dezembro de 2006. Todos foram submetidos à simpatectomia do terceiro gânglio torácico por videotoracoscopia e aleatorizados para receber ou não drenagem pleural pós-operatória por 3 h. Todos foram avaliados no pós-operatório imediato com radiogramas de tórax e tomografia computadorizada de tórax de baixa emissão de energia para detecção de pneumotórax residual. Foram avaliados quanto à dor pós-operatória em diferentes momentos até o 28º dia de pós-operatório, por meio de escala numérica visual e dosagem requerida de analgésicos opióides. RESULTADOS: Foram incluídos 56 pacientes neste estudo, 27 com drenagem pleural bilateral e 29 sem drenagem pleural. Não houve diferença estatística entre a incidência de pneumotórax residual após simpatectomia com e sem drenagem pleural. O pneumotórax residual, quando presente e diagnosticado por qualquer um dos métodos, não influenciou a dor pós-operatória até o 28º dia. CONCLUSÃO: Concluiu-se que a drenagem pleural tubular fechada, por um período de 3 h, no pós-operatório imediato de simpatectomia torácica videotoracoscópica, foi tão eficiente quanto a não drenagem, em relação à reexpansão pulmonar e à presença de pneumotórax residual. O pneumotórax residual, quando presente, não interferiu na dor pós-operatória até o 28º dia.
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Molins L. [Ambulatory chest surgery]. Arch Bronconeumol 2007; 43:185-7. [PMID: 17397581 DOI: 10.1016/s1579-2129(07)60049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rocco G. Endoscopic VATS sympathectomy: the uniportal technique. Multimed Man Cardiothorac Surg 2005; 2005:MMCTS.2004.000323. [PMID: 24413770 DOI: 10.1510/mmcts.2004.000323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Presentation of the uniportal VATS sympathectomy technique: through a single port incision, a videothoracoscope, a diathermy hook and, if needed, a lung grasper are introduced into the pleural cavity. Upon identification of the sympathetic chain, the relevant ganglia are divided. By extending laterally the dissection, the aberrant accessory sympathetic nerve fibers are also severed. Anatomic variations are illustrated and an overview of the literature is presented.
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Affiliation(s)
- Gaetano Rocco
- The Price-Thomas Thoracic Unit, Directorate of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield S5 7AU, UK
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