Thoracic Surgery












Endoscopic Thoracic Sympathectomy

Endoscopic Thoracic Sympathectomy is utilized to treat Hyperhidrosis (excessive sweating of hands, underarms and face). The facial blushing can also be improved............ HYPERHIDROSIS: Excessive sweating beyond the physiological need, It could be disabling in private and professional life............ SYMPTOMS AND SIGNS: Excessive sweating of palms, soles (Emotional Hyperhidrosis), axillae, face, +/- blushing. Embarrassing to shake or hold hands. Difficulty handling objects and tools, writing or typing on a computer. Difficulty playing musical instruments or sports. Need to wear and frequently change gloves. Inability to wear certain clothes or shoes. Exacerbation of eczematous dermatitis, fungal or bact. infections. Anxiety, psychological and emotional problems - social phobia. Occupational and educational difficulties........... INCIDENCE: previously thought to affect 1% of population, recent study from UCLA - 5% may be at risk. Underreported - embarrassing problem - not reported to Physicians................................................................. TREATMENTS: Directed to the underlying cause if generalized. Behavior modification - light clothes, avoidance of stressful situations. Psychotherapy and biofeedback. Medicines: Topical antiperspirants. Drysol 20% apply to affected areas qhs, wash off in AM Anticholinergics (Atropine, Ditropan, Robinul). Iontophoresis (Drionics) - current applied to hands and feet in the basin of water. Botox injections - painful, temporary and expensive. SURGERY - local excision or liposuction of axillary skin that includes sweat glands. -.......................................................................................................................................
... ENDOSCOPIC THORACIC SYMPATHECTOMY: Minimally invasive, mostly an outpatient procedure. Under general anesthesia. Sympathetic nerves of both sides are transected/removed through two 5mm ports utilizing the Harmonic Scalpel (cuts at low temperature to prevent lateral damage to other tissues), cautery or clips. Symptoms and presentation determines level of sympathetic chain and ganglia addressed. Pts wake up with dry and warm hands and go home in 2-3 hours. Return to school or work in 3-5 days............ RESULTS: Cure of sweaty palms in 90-99% of cases. Cure of sweaty armpits 75-90% if associated with hand sweating. Feet are cured or improved in 60-70% of cases if associated with palmar HH. Facial sweating or blushing cured in 85-90%............ COMPLICATIONS: Horner’s syndrome (1% and usually temporary). Pneumothorax, bleeding, infection, neuralgia or weakness - rare. ...........SIDE EFFECTS: Compensatory sweating - 20-86%, usually occurs with exertion or hot weather - mostly well tolerated, severe in 3-5%. Usually does not improve with time, but it may. Gustatory sweating - 10-25%............ TREATMENT FAILURE: 1-10% - Caused by - pleural adhesions in 58%. - incorrect ID of the proper ganglion. - anatomic variations - vessel overriding the sympathetic chain. - incomplete interruption of the chain. - missed aberrant branches (Kuntz nerves). - overload of adipose tissue. - renervation............ OTHER INDICATIONS FOR ETS: Raynaud’s Disease. Causalgia, RSD, vascular insufficiency, intractable pancreatic pain. Long QT interval syndrome............ CONTRAINDICATIONS: Severe cardiac or pulmonary insufficiency. History of pleural disease (TB, empyema, severe pleuritis). Untreated hyperthyroidism. ...........CONCLUSIONS: Hyperhidrosis - more common than previously thought. Affecting all aspects of the patient’s personal and professional life. Medical therapy sometimes effective. ETS - provides immediate and permanent cure in majority of patients. Low risk of side-effects and complications. High patient satisfaction.





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Pulmonary surgery

Resection of tumors of the lung, pleura (lining of the chest cavity) and the chest wall.


Surgery of esophagus

Evaluation and treatment of gastro-esophageal reflux disease and its complications such as Barrett’s esophagus, esophageal cancer and emergencies such as perforation.


Video assisted thoracic surgery

Diagnostic procedures such as direct examination and lung, pleura or lymphnode biopsy utilizing advanced video technology inserted into the chest via small openings between the ribs.

 Video assisted thoracic surgery


Endoscopy

Diagnosis of disease of inner lining of the trachea and bronchial tree; usually in conjunction with lung surgery surgery.


Trauma

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