ABSTRACT
BACKGROUND: After a large experience (more than 10 years) with bilateral endoscopic thoracic sympathectomy (ETS) surgery on an outpatient basis, we studied prospectively a multimodal approach to rapid discharge patients undergoing this procedure. METHODS: One hundred and seventeen consecutive patients, aged 13-60 years, ASA physical status I or II, undergoing outpatient ETS under general anaesthesia were enrolled in this study. All patients were managed using a predefined multimodal clinical care protocol consisting of a general balanced anaesthesia. Basic demographic information was collected from each patient. Duration of surgery and anaesthesia and times to PACU and home discharge were recorded as well as intraoperative and postoperative complications like nausea and vomiting. RESULTS: Surgery took 41.4 +/- 22.1 min and anaesthesia lasted 63 +/- 21.5 min. Time between induction of anaesthesia and beginning of surgery and end of surgery to extubation was 15.0 +/- 2.0 and 7.2 +/- 3.1 min, respectively. It took 4.9 +/- 1.5 min from extubation to OR discharge. Time from PACU arrival to discharge was 12.8 +/- 6.3 min. Time of hospital stay was 132 +/- 18 min. No patient experienced vomiting and two had nausea, representing an incidence of 1.7%. The only anaesthetic cause for hospital admission was a severe allergic reaction. CONCLUSION: 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.
Subject(s)
Ambulatory Surgical Procedures/methods , Sympathectomy/methods , Thoracoscopy/methods , Adolescent , Adult , Anesthesia, General/adverse effects , Anesthesia, General/methods , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antiemetics/therapeutic use , Combined Modality Therapy , Female , Humans , Length of Stay , Male , Middle Aged , Patient Discharge , Postoperative Complications/prevention & control , Prospective StudiesABSTRACT
BACKGROUND: The ethiopathogenic diagnosis of rhinitis is laborious and the clinical treatment is unsatisfactory in many cases. After endoscopic thoracic sympathicotomy (ETS), some patients related improvement of the symptoms of chronic non-infectious rhinitis (CNIR). AIM: To study the influence of ETS associated with the severing of the Kuntz nerve in the follow-up of patients suffering from CNIR. MATERIAL AND METHOD: From October, 1993 to February, 2001, 117 patients (post-op. follow-up from 2 to 88 months; 46 males and 71 females; median age 24.9 years) were submitted to bilateral ETS and severing of the Kuntz nerve for treatment of hyperhidrosis and chronic non-festering rhinitis. The sympathetic trunk was severed at different levels according to hyperhidrosis location and rhinitis. RESULT: Rhinitis was cured in 52 patients (44.4%), was improved in 43 patients (36.8%), and in 22 patients (18.8%) there was no change. In 3 patients specifically operated on for treatment of CNIR, symptoms disappeared. CONCLUSION: The results of the present investigation confirmed the benefits of ETS associated with severing of the Kuntz nerve in the treatment of CNIR. We recommend this procedure for the treatment of rhinitis associated with hyperhidrosis and also for the treatment of specific, isolated cases of CNIR.
Subject(s)
Endoscopy , Intercostal Nerves/surgery , Rhinitis/surgery , Sympathectomy/methods , Adolescent , Adult , Child , Child, Preschool , Chronic Disease , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Video-endoscopic sympathicotomy for the treatment of palmar, axillary, facial and palmar-plantar hyperhidrosis was modified as to the type of surgical access and the level of incision in the sympathetic chain and communicating rami, depending on the clinical indications. Under general anaesthesia, using a single lumen endotracheal tube, the patient is put in lateral decubitus and pneumothorax is induced. The patient is then placed in ventral decubitus, with the head elevated, to make two punctures in the posterior axillary line, at the level of the 4th and 7th intercostal spaces, to introduce two ports of 5 and 10 mm in size, respectively. The sympathetic chain and the communicating rami are viewed and severed, according to the indications, at different levels to treat palmar, axillary, facial and palmar-plantar hyperhidrosis and combinations of the above. The operation is performed on both sides of the thorax during the same period of anaesthesia. One hundred-forty patients (280 procedures) have been operated on from 1993 to 1997 using this technique. All were operated on as outpatients. Our results are: 100% of those with facial and palmar hyperhidrosis and 96% of those with axillar hyperhidrosis were cured, and 94% with plantar hyperhidrosis were relieved from 50 to 100%, with the follow-up of between one and 47 months.
