ABSTRACT
Abstract Erythromelalgia is a rare disease, involving pain, edema, redness, and hyperthermia in the limbs. It is extremely refractory to drugs, has no defined treatment, and causes psychological comorbidities in the patient. We describe a case of erythromelalgia involving a 17-year-old boy who had been suffering from the disease for almost 4 years prior to finding an effective treatment. A bilateral endoscopic lumbar sympathectomy was performed, limited to L2 and L3 resections. Four weeks after the procedure, the patient's symptoms were significantly mitigated and at 8 months follow-up he remained almost asymptomatic. Endoscopic lumbar sympathectomy was an effective treatment for primary erythromelalgia in this teenager, with exceptional reduction of his symptoms.
Resumo Eritromelalgia é uma doença rara caracterizada por dor, edema, eritema e hipertermia nos membros. É extremamente refratária a medicamentos e não tem um tratamento definido, causando comorbidades psicológicas para o paciente. Descrevemos o caso de um menino de 17 anos que possuía eritromelalgia há quase 4 anos antes de ser submetido a um tratamento efetivo. Foi realizada simpatectomia lombar endoscópica bilateral limitada à ressecção dos gânglios L2 e L3. Após 4 semanas do procedimento, o paciente teve diminuição significativa dos seus sintomas e, com 8 meses de seguimento, permanece praticamente assintomático. A simpatectomia lombar endoscópica foi um tratamento eficaz para eritromelalgia primária em um adolescente, com redução excepcional dos seus sintomas.
ABSTRACT
Abstract Severe palmoplantar hyperhidrosis affects about 1.5-2.8% of the general population. Plantar hyperhidrosis (PHH) is related to foot odor, cold feet, skin lesions and infections, and even instability when walking. Endoscopic Lumbar Sympathectomy (ELS) is the treatment of choice for this condition. However, few surgeons have used this technique over the past 20 years because of its technical difficulty. Two and 3 mm instruments, rather than the standard 5 mm instruments, have been used to improve the results of several standard laparoscopic procedures. Use of these minilaparoscopic instruments to perform ELS so far has not yet been published. We describe a technique for ELS using minilaparocopic instruments, which we have used for our last 70 cases and has become our standard technique. The aim of this study is to demonstrate the feasibility of this technique and its advantages compared to the conventional technique.
Resumo A hiperidrose palmoplantar grave afeta cerca de 1,5-2,8% da população geral. A hiperidrose plantar está relacionada a odor dos pés, pés frios, lesões cutâneas, infecções, e até instabilidade da marcha. A simpatectomia lombar endoscópica (endoscopic lumbar sympathectomy, ELS) é o tratamento de escolha para essa condição; entretanto, tem sido utilizada por poucos cirurgiões nos últimos 20 anos, devido à sua dificuldade técnica. Instrumentos de 2 e 3 mm em vez de 5 mm vêm sendo utilizados para melhorar os resultados de vários procedimentos laparoscópicos padrão. O uso desses instrumentos para realizar ELS ainda não foi descrito. Descrevemos a técnica para ELS usando microinstrumentos, a qual vem sendo usada para os nossos últimos 70 casos, pois passou a ser nosso procedimento padrão. O objetivo deste estudo é apresentar a experiência com essa modificação técnica, assinalando as vantagens em relação à técnica tradicional.
Subject(s)
Humans , Sympathectomy/instrumentation , Hyperhidrosis/surgery , Lumbosacral Plexus/surgery , Sympathectomy/methods , Endoscopy/instrumentation , FootABSTRACT
A 39-year-old female was suffering from cold-induced Raynaud's attacks in both hands and feet, with symptoms being most severe in her left foot. The patient did not respond to medical treatments and was referred to our department of pain medicine. We performed sequential bipolar radiofrequency lumbar sympathectomy to the patient, which offered a long duration of symptom relief. Sequential bipolar radiofrequency lesions could create continuous strip lesion, and thus, could achieve better results, while the potential risk of liquid neurolytic agents could be avoided.
Subject(s)
Adult , Female , Humans , Foot , Hand , Raynaud Disease , Stress, Psychological , SympathectomyABSTRACT
Objective To study systematically regional anatomy of lumbar sympathetic trunk to provide anatomic information for endoscopic lumbar sympathectomy (VALLS). Method The anatomy of the lumbar sympathetic trunk and its relationship with neighboring structures were studied in 128 sides of adult cadavers, and it was substantiate in 13 cases of endoscopic lumbar sympathectomy. Results (1) The location, shape and number of the sympathetic ganglia were quite variable. The number varied from 1 to 6 on one side. (2) It was found that the lumbar sympathetic trunk split into 2-3 branches at the distal portion. (3) Lumbar arteries were all located under the lumbar sympathetic trunk and the lumbar veins situated superior to the trunk in 68.42%±4.35% of instance. (4) Genitofemoral nerve was found to pierce the psoas muscle at the level of 2nd to 4th vertebra or its intervertebral discs. It was only 0.81±0.48 cm away from the medial rim of the psoas muscle. (5) Distance between ureter- iliac vessel junction and the lateral edge of the psoas muscle was 3.36±0.59 cm on the left side, and 3.41±0.59 cm on the right side. (6) A report of the experience of our 13 VALLS was presented. Conclusions Because of great variation and complicated anatomic relation between lumbar sympathetic trunk with its neighboring structures, familiarity to the anatomy of the retroperitoneal space is cracial for a successful minimal invasive laparoscopic lumbar sympathectomy.
ABSTRACT
Objective:To review the effects of video-assisted laparoscopic lumbar sympathectomy combined with in situ aterializa tion of the great saphenous vein for the treatment of thromboangiitis obliterans. Methods:From January 2005 to December 2006,12 patients with thromboangiitis obliterans were treated in our hospital with laparoscopic lumbar sympathectomy combined with in situ aterialization of the great saphenous vein. Results:Twelve limbs were followed-up from 6 months to 2 years.The intermittent claudication was delayed,and night pain was relieved or disappeared in all cases. Conlusion:Because of its small incision,little wound,and satisfactory efficacy,the present operation is applicable in clinic.
ABSTRACT
Primary hyperhidrosis, a disorder of unknown etiology, is characterized by excessive uncontrollable sweating, most often of the palm surface of the hands, armpits, groin and feet. To decrease the symptoms of hyperhidrosis, drug therapy, iontophoresis, excision of axillary sweat glands and thoracoscopic sympathectomy have been attempted. A lumbar sympathectomy is one of the available choices for the treatment hyperhidrosis of the lower extremities. A 28-year old female patient presented with excessive sweating of her hands and feet. For the treatment of her foot hyperhidrosis, a bipolar radiofrequency ablation system was used to ablate the lumbar sympathetic ganglion, with a successful result. This modality will receive greater attention as an available alternative to lumbar sympathetic neurolysis.
Subject(s)
Adult , Female , Humans , Catheter Ablation , Drug Therapy , Electrocoagulation , Foot , Ganglia, Sympathetic , Groin , Hand , Hyperhidrosis , Iontophoresis , Lower Extremity , Sweat , Sweat Glands , Sweating , SympathectomyABSTRACT
Objective: To explore the Prevention and Cure of the Complications of video - assisted Laparoscopic Lumbar Sympathectomy (VALLS). Methods; 13 cases of Buerger' s disease treated with VALLS were retrospectively reviewed. Results; Serious complications were not found in all the patients. Only two cases developed aerodermectasia. Conclusions: VALLS is the ideal minimally invasive surgery for Buerger's disease. Only then grasps the laparoscopic operation skill and anatomy of retroperitoneal space, protects the neighbor important structures, can the complication fall to the lowest.
ABSTRACT
Objective:To review the feasibility and efficacy of partial lumbar sympathectomy for Buerger's disease with video-assisted laparoscopic lumbar sympathectomy (VALLS).Methods:From July 2002 to Octomber 2003,7 patients with Buerger's disease were treated in our hospita1 with VALLS.3 cases underwent bilateral resection,3 cases left side resection,1 case right side resection,1 case common femoral-superficial femora1 artery bypass,1 case right greater saphenous vein arterialization,and 2 cases toes amputation.Results:All the 7 cases were confirmed by pathological examination(one was reported as one lymph node).The skin temperature of lower limb immediately rose significantly after operation.Serious complications were not found in all the patients.Only one case developed aerodermectasia,but recovered completely after three days of symptomatic therapy.Follow-up survey of 2-18 months(with mean of 8.7 months)showed the effect was satisfactory with the manifestations of normal limb temperature,improved blood supply,remission and resolution of the pain.Conclusion:Because of its small incision,little wound,excellent view of the retroperitoneal space and accurate anatomical location,VALLS is relatively simpler than classical operation and its effect is satisfactory.
ABSTRACT
Objective To research regional anatomy of lumbar sympathetic trunk and provide anatomic information for video-assisted laparoscopic lumbar sympathectomy(VALLS).Methods Lumbar sympathetic trunk and its neighboring anatomic relation in 128 sides of adult cadavers and 21 clinic VALLS were retrospectively reviewed.Results ① The location,shape and number of the sympathetic ganglia were quite variable.There was 1 to 6 in number unilaterally.② Lumbar sympathetic trunks of 12 sides in 128 sides were found dividing into 2-3 branches at the distal part.③ Lumbar arteries were all located under the lumbar sympathetic trunk and the lumbar veins consisting 68.42% situated superficially to the trunk.④ Genitofemoral nerve pierced the psoas muscle at the level of 2nd to 4th vertebrate or its intervertebral disc.It was only(0.81?0.48)cm away from the medial rim of the psoas muscle.⑤ Distance between ureter-iliac vessel junction and the lateral rim of the psoas muscle was(3.36?0.59)cm at left side and(3.41?0.59)cm at right side.The operation time was 2-3.5 hours and the intraoperative blood loss was 50-80 ml.There were no severe complications and the effects were satisfying.Conclusion Because of great variants and complex neighboring anatomic relation of lumbar sympathic nerve,the critical factor of successful microinvasive VALLS is to grasp the laparoscopic operation skill and anatomy of retroperitoneal space(especially the regional anatomy of lumbar sympathetic trunk)and carefully operating.
ABSTRACT
Objective To study the effect of thoracoscopic sympathectomy and/or chemical lumbar sympa- thectomy performed on patients with Raynaud disease. Methods Five patients, 1 male,4 females, aged from 30 to 65(mean 45. 3 ). Raynaud phenomenon appeared only on both hands in one patient, only on feet with a toe gangrene in another one , the other 3 cases on all limbs. Thoracoscopic symathectomy was performed for those whose hands were af- fected and chemical lumbar sympathectomy(12-3 ) was pererformed for those whose feet were affected. Results All patients were followed up from 12 to 48 months(mean 24 months). All experinced improvement with hands warm and satisfactory results after thoracoscopic sympathectomy. However, the original symptoms reccurred in two patients after postoperatire six months. All 4 patients performed chemical lumbar sympathectomy experienced improved symptoms with feet warm and satisfactory results and the symptoms did not recur up to now. The sympathectomy showed different results for hands and for feet. Conclusions Thoracoscopic sympathectomy for hands affected by Raynaud disease has efficiency temporarily, but is not satisfactory. The chemical lumbar sympathectomy for the feet affected by Raynaud disease has dramatically disappearence of symptoms and the results are very good
ABSTRACT
Seven cases of retroperitoneal laparoscopic lumbar sympathectomy were successfully performed in 10 patients with ischemic lesions of lower limbs or ischemic rest pain between June, 1996 and October, 1996. All patients had nonreconstructable distal vessels on femoral angiogram. Our techniques of retroperitoneal laparoscopic lumbar sympathectomy is described in detail. Procedure offers the advantage of minimally invasive surgery and can be performed more efficiently as the experience of the surgeon accumulates.
Subject(s)
Humans , Lower Extremity , Minimally Invasive Surgical Procedures , SympathectomyABSTRACT
Neurolytic or surgical lumbar sympathectomy are commonly used in the treatment of intractable pain and peripheral ischemia. The primary goal of sympathectomy for pain management is to achieve a good result with minimal interruption of nervous tissue and as few side effect as possible. A high incidence of postoperative bleeding, ureteral injuries have been reported in surgical sympathectomy and chemical neuritis or paresthesia has been reported with an incidence of 2~10% in nerurolytic sympathectomy. Of the techniques which have been applied for sympathectomy, the radiofrequency lesion method has emerged as the most effective with less complications. But, a series of modifications have been tried in an effort to improve results. The more extensive lesions are thought to produce the more effective sympatholysis. We inserted two cannulas for making lesions to one ganglion and 3 or 4 lesions were made at each level. Sympathectomy using this technique was successful in thirteen out of fifteen patients. This new modified technique has improved the effectiveness of stereotactic radiofrequency lumbar sympathectomy as compared with other previous reports.
Subject(s)
Humans , Catheters , Ganglion Cysts , Hemorrhage , Incidence , Ischemia , Neuritis , Pain Management , Pain, Intractable , Paresthesia , Sympathectomy , UreterABSTRACT
Pain is a sensory experience that is subjective and individual. It frequently exceeds its protective function and becomes destructive. We have met one case of causalgia, three cases of Buergers disease, and one case of arteriosclerosis obliterance. They sufferred from persistent pain and exkausted with the marked distrophy of affected limbs. Management of these patient involving lower limbs is a continuing challenge. Many other therapheutic procedures could be tried for these patients, but we tried chemical lumbar sympathectomy for these cases. With respect to the lower extremity, four patients had neurolysis of the 1st, 2nd and 3rd ipsilateral or 2nd and 3rd bilateral lumbar ganglia using 3 to 5 ml pure alcohol for each space under the image intensifier. Immediately after these procedure, rest pain has relieved dramatically in most cases and marked skin temperature rising. This implied increased peripheral blood flow of sympathectomised portion and the relief of rest pain is probably explained by destrcution of the afferent pain fibres running with the sympathetic trunk.
Subject(s)
Humans , Arteriosclerosis , Causalgia , Extremities , Ganglia , Lower Extremity , Running , Skin Temperature , Sympathectomy , Thromboangiitis ObliteransABSTRACT
The lumbar sympathectomy was performed for the treatment of 25 patients with Buerger's disease. 80% of patients received lumbar sympathectomy achieved improvement of clinical symptoms and signs. The lumbar sympathectomy had good results in following cases: 1) Patients with resection of L1 sympathetic ganglion which was performed completely, anatomically and widely. 2) Patient received operation within the 6th months of initial occurrence of symptoms. 3) Patients which main symptoms were rest pain, coldness and numbness. In case of resection which was included of L1 sympathetic ganglion, postoperative skin temperature measured on medial aspect of tibia was higher than normal side about 1degrees C. The prognosis was poor in patients which ulceration and necrosis were previously existed. Stop smoking must be preceded for the treatment of Buerger's disease.
Subject(s)
Humans , Ganglia, Sympathetic , Hypesthesia , Necrosis , Prognosis , Skin Temperature , Smoke , Smoking , Sympathectomy , Thromboangiitis Obliterans , Tibia , UlcerABSTRACT
Objective To compare the video-assisted laparoscopic lumbar gangliosympathectomy with open lumbar gangliosympathectomy on their advantages and disadvantages. Method From June 2002 to May 2006, a total of 21 adults with Buerger's disease underwent the video-assisted laparoscopic lumbar gangliosympathectomy. The operation time, intraoperative blood loss, hospitalization time, postoperative effects and postoperative complications were analyzed. The data of the 21 cases were compared with those from other 27 cases with Buerger's disease who had undergone open lumbar gangliosympathectomy in the same period. Results The operation time was longer in the laparoscopic group (174?14.84min) than that in the open group (132?32.81min, P