Multimodal approach to rapid discharge after endoscopic thoracic sympathectomy

Cruvinel, Marcos Guilherme Cunha; Duarte, João Bosco Vieira; Castro, Carlos Henrique Viana de; Costa, J. R. R.; Kux, Peter

doi:10.1111/j.1399-6576.2004.00558.x

Cited by 13 publications

(6 citation statements)

References 31 publications

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“…Today, these patients are operated on early in the afternoon programme and discharged the same evening. Due to the underlying pathology of the patients, we think that it would be difficult to improve LB substitution index, but MC-SI could rise to nearly 95%, and most TS could be performed as outpatient procedures as demonstrated by others [12][13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 98%

“…Although the procedure is usually performed in young healthy people, most patients stay one night because of pain, nausea or vomiting. The key to this is anaesthetic technique and premedication with analgesic and antiemetic agents [15,16]. Moreover, systematic intercostal infiltration with local anaesthetic may help in this issue.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, thoracoscopic sympathectomy has become the most widely used approach to thoracic sympathectomy (TS) in the management of primary hyperhidrosis and facial blushing. Some authors conclude that thoracoscopic sympathectomy is a safe and effective outpatient procedure [10][11][12][13][14][15][16][17]. The aim of this study was to evaluate the clinical aspects, results and economic impact of the outpatient thoracic surgery programme (OTSP) developed in our Department.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Outpatient thoracic surgical programme in 300 patients: clinical results and economic impact☆

Molins¹,

Fibla²,

Pérez³

et al. 2006

European Journal of Cardio-Thoracic Surgery

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Outpatient thoracic surgical programme in 300 patients: clinical results and economic impact☆

Molins¹,

Fibla²,

Pérez³

et al. 2006

European Journal of Cardio-Thoracic Surgery

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“…Neuroendoscopes utilize long, narrow-diameter rod lenses with short focal lengths and “direct in-line” visual trajectories, resulting in a relatively fixed, narrow field of view that is easily obscured with the introduction of surgical instruments or with moderate to brisk bleeding. [ 14 ]…”

Section: Discussionmentioning

confidence: 99%

A practice survey to compare and identify the usefulness of neuroendoscope and exoscope in the current neurosurgery practice

et al. 2020

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Background: The present era is of new tools and technique. Handling of new challenges require, better understanding of microscopic anatomy, which requires better magnification and light. Microscope has played significant role in this, use of endoscope and introduction of exoscope have given new dimensions to this field. Aim: This study aims to compare and see the advantages, disadvantages of endoscope with exoscope, will analyze the difference in terms of ergonomics, learning curve, opportunities for training, operating time, magnification, and image quality. Materials and Methods: This study was conducted in the Department of Neurosurgery, Bantane Hospital Fujita Health University, Japan. Apart from comparing the specifications of available systems, we conducted a worldwide survey of the two systems through sending questionnaire through mail collected responses and analyzed them. Results: Learning curve, magnification, image quality, and ergonomics favors exoscope but depth perception and maneuverability, hand eye coordination, tactile sensation, and usage of different angulation tubes favored endoscope to be superior to exoscope. Conclusion: There is more scope for modifications and research in both the instruments. These instruments are not replacement of either and should be used according to their indications.

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“…(12)(13)(14)(15) The routine of the procedure varies immensely, taking into account the type of tracheal intubation used, the technique for dissection, blockage or excision of the sympathetic chain, postoperative closed pleural drainage or not, among other aspects. (4,9,12,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) However, findings in the literature seem to agree on key points: resections of the chain should be as minimal as possible; we should never remove more than one ganglion from the chain; and dissection should begin as caudally as possible, bearing in mind the final objective. (27) In this study, we observed excellent remission rates of palmar and plantar hyperhidrosis, with acceptable rates of compensatory sweating (28) and without any severe or intolerable cases, only by excising completely the third ganglion of the sympathetic chain.…”

Section: Discussionmentioning

confidence: 99%

Incidência de pneumotórax residual após simpatectomia torácica videotoracoscópica com e sem drenagem pleural e sua possível influência na dor pós-operatória

Lima¹,

Marcondes²,

Teixeira³

et al. 2008

J. bras. pneumol.

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Objective: To determine the incidence of residual pneumothorax after video-assisted thoracic sympathectomy, with and without postoperative pleural drainage, and to evaluate the possible influence of this type of pneumothorax on postoperative pain within the first 28 postoperative days. Methods: All patients presenting symptoms consistent with primary palmoplantar hyperhidrosis and treated at the Thoracic Surgery Outpatient Clinic of the State Hospital of Sumaré between July and December of 2006 were included. All were submitted to sympathectomy up to the third ganglion using video-assisted thoracoscopy and were randomized to receive or not receive postoperative pleural drainage for 3 h. Chest X-rays and low-dose computed tomography scans of the chest were performed on the first postoperative day in order to determine the incidence of residual pneumothorax. At different time points up to postoperative day 28, patient pain was assessed using a visual numeric scale and by measuring the quantity of opioid analgesics required. Results: This study comprised 56 patients, 27 submitted to bilateral pleural drainage and 29 not submitted to drainage. There was no statistical difference between the two groups in terms of the incidence of post-sympathectomy residual pneumothorax. Residual pneumothorax diagnosed through any of the methods did not influence pain within the first 28 postoperative days. Conclusion: Performing closed pleural drainage for 3 h immediately after video-assisted thoracic sympathectomy did not affect lung re-expansion or the incidence of residual pneumothorax. When residual pneumothorax was present, it did not affect pain within the first 28 postoperative days.Keywords: Hyperhidrosis; Sympathectomy; Pain, postoperative; Pneumothorax; Drainage; Pleura. ResumoObjetivo: 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, q...

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Multimodal approach to rapid discharge after endoscopic thoracic sympathectomy

Abstract: Multimodal management to rapid discharge after ETS surgery did result in a short time to patient discharge. We confirm that endoscopic thoracic sympathectomy can be performed safely on an outpatient basis with brief postoperative hospital care and a low rate of complications.

Cited by 13 publications

References 31 publications

Outpatient thoracic surgical programme in 300 patients: clinical results and economic impact☆

Outpatient thoracic surgical programme in 300 patients: clinical results and economic impact☆

A practice survey to compare and identify the usefulness of neuroendoscope and exoscope in the current neurosurgery practice

Incidência de pneumotórax residual após simpatectomia torácica videotoracoscópica com e sem drenagem pleural e sua possível influência na dor pós-operatória

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