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.
ABSTRACT
The aim of this paper is to determine the possibilities of modern radiofrequency (RF) technology and the usefulness of abdominal and thoracic parenchymatous organs in surgery. Investigation was made on 17 patients with 125 RF energy realized cycles (an average of 7.35 per one pt.) and the average time heating coagulative necrosis of 42.6 minutes (maximum to 80 minutes). There was one complication (pleural effusion) in a patient with RF treatment of 5 metastases colorectal carcinoma (MCRC) and synchronous right hemicolectomy. There were no other complications either to close or to distant to the organs. The urgent need of RF technology was in the case of a patient with iatrogenic rupture of spleen, treated by radiofrequency coagulation (RFC) with documented preservation of the whole organ. Most of the patients with MCRC (64%) were intraoperatively treated with a combination of radiofrequency ablation (RFA) and radiofrequency assisted resection (RFAR) of the liver with success in 95% of the cases. In the surgery of echinococcal liver cyst located deep, in the parenchyma, RFA were used for scolicidal purpose, and for hepatotomy. In the treatment of lung malignancies RF technology was reserved for nonsurgical candidates suffering from NSCLC, but also for surgical patients as a palliative measure in the treatment of local symptoms related to non-resectable primary and secondary tumors, presenting an aggressive tumor growth on the thoracic wall and the great vessels, with the possibility of reducing the number of explorative thoracotomy.
