Video-assisted and thermometrically controlled thoracoscopic sympathectomy demonstrates new ways in the treatment of upper-limb hyperhidrosis. An anatomical portrayal of the sympathetic chain is possible as a result of the improved visualization and magnification of the operative area provided by the video-optic technique. The difference in temperature, registered by means of a thermometric sensor in the palm of the hand, indicates that the sympathetic nerves responsible for the hyperhidrotic segments have been severed. The number of postoperative Horner's syndromes will be reduced significantly with this method. Until now, we have successfully treated six thermometrically controlled patients. No recurrences have arisen during an 18 months observation period. Neither intraoperative nor postoperative complications were recorded. One patient complained of increased compensatory sweating of the trunk. Thermometrically controlled thoracoscopic sympathectomy is expected to improve the various forms of treatment available for sympathetic reflex dystrophies in the future.

In contrast to its use in other surgical disciplines, intraoperative sonography has so far been of minor importance in thoracic surgery. The technique of intrathoracic, intraoperative, ultrasonic examination was applied in 85 patients with different indications: in 61 patients during thoracoscopy, in 24 patients during open thoracic surgery. 6 patients eventually underwent a combination of both procedures. In order to improve the intrathoracic maneuverability of the sonographic probe we developed an electrically controllable handle for the probe. The examinations showed a high sensitivity of thoracoscopic ultrasonography for localization of intrapulmonary tumors. In addition, ultrasound was applied to assess the operability of central tumors. The sound frequency available so far for intraoperative application allows a safe distinction of non-infiltrating tumors from vascular structures; the reliable identification of an infiltration mostly requires a higher resolution. If our experiences are confirmed by further application of the method, explorative thoracotomies will surely be partly replaced by explorative thoracoscopic interventions. Ultrasonography has also proved to be useful in visualisation of mediastinal lymph-nodes and tumors, with the possibility of assessing their size.

During the last tw o to three years th e scope of video-assisted thoracoscopic surgery has Increase d rapidly. mainly because of improvement in the tec hnica l proroqutsttes such as easy-to-use sma ll video ca mera s and the deve lopmen t of spectul instrume nts. Use of the endoscope in thora cic surgery has 11 long tradi tion. Followi ng his in troduction of thora coscopy in 191 0 (2), Jacotaeus developed thoracoscopic techn iques for adhesiotomy and pneumothorax treatm ent over the next years. Kux described thoracoscopic sympathectomy in 1948 (3) and Witt moser vagotomy in 195 5 (9). Maaftell developed endoscopic methods of lung biopsy and empyemic removal (5, 6), The real breakthrough of endoscopic surgery, however, came with tho introduction of the video tech nique. Minimally Invasiv e sur gery (M[S) ha s been quickly adopted for extensive use in abdomina l surgery. According to statements by Manegold (Surgical Study Group for Endo scop y of the German Society of Sur gery) and Hempel (Professional Association of Germ a n Surgeons) at the Internationa l Symposium "Minimally Invasi ve Surgery" in Erlangen. 21.-23.1.1993. there is already uncontrolled growth in education for laparoscopic surgery. Amo ng othe r th ings. courses in this speciality are often olTered by people ca lling themselves tutors. and dip lomas a wa rded. This leads to a non-sta nder dtzed and vague levu! of education in the rising gene ration of surgeons and an overes timati on of the ir own a bilities. At the inte rn ational lapa roscopic training-course in Devos. 1.-4.3. 93 , a marked incre as e in com plica tions such a s, c.g., perforation of th e intestine and vascular injuri es. was also reported. These complications are har dly ever encountered in open a bdominal surgery today. In the USA, a s a res ult of the ma rked rise in complications with MIS. guideli nes for th is for m of surgery, as well as for thoracoscopic surgery. have been issued (8). Approp r ia te gutdelrnes have a lso been developed by the Committee on Minimally Invasive Surge ry of th e German Society for Thoracic Surgery (Adden dum). Pr erequisit es for MIS in the thorax Thoracoscopi c surgery pr esupposes cons idera ble expertonce in tho racic operating on the pa rt of the surgeon. Not only must he und ertake th e operation with a two-dimen

In a pilot study involving six patients, palmar thermometry was used as a non-invasive method for intraoperative success control during thoracic sympathectomy. Using commercially available thermo-elements and amplifier modules, a marked increase in temperature could be registered in five patients after the severance of their rami communicants grisei for the hand. This effect was associated with the long-term success of therapy for hyperhidrosis in all five patients. This initial experience demonstrates that palmar thermometry is sensitive enough to measure surgical success intraoperatively. The limit of the thoracic sympathectomy in the cranial direction is indicated intraoperatively and Horner's syndrome is avoided with certainty.

No abstract

Grade of differentiation cannot be assessed Gx Differenzierungsgrad kann nicht beurteilt werden G1 Well differentiated G, Gut differenziert G2 Moderately differentiated GZ Mäßig differenziert G3 Poorly differentiated G3 Schlecht differenziert G4 Undifferentiated G4 Undifferenziert.

No abstract

No abstract