[Thoracoscopic sympathectomy for palmar hyperhidrosis. Immediate results and postoperative quality of life]. / Tratamiento de la hiperhidrosis palmar por simpatectomía torácica. Resultados inmediatos y calidad de vida postoperatoria.

OBJECTIVE: Primary palmar hyperhidrosis is a socially and occupationally debilitating disorder characterized by excessive sweating. The purpose of this study was to evaluate the results, complications, and degree of satisfaction among patients who underwent video-assisted bilateral thoracoscopic sympathectomy of the second and third ganglia (T2-T3) to treat primary palmar hyperhidrosis at the Department of General and Thoracic Surgery of the Hospital Universitario Virgen Macarena in Seville, Spain. MATERIAL AND METHOD: A study of 226 thoracoscopic sympathectomies was undertaken based on case histories and a prospective pre- and postoperative questionnaire survey. The sample was composed of 113 patients (47 males and 66 females), ranging in age from 14 to 50 years, with primary palmar and axillary hyperhidrosis, in some cases severe. Bilateral video-assisted thoracoscopic T2-T3 sympathectomy was performed under general anesthesia in all cases. Follow up included a questionnaire on pre- and postoperative quality of life and degree of satisfaction. Descriptive statistics on the surgical procedure, quality of life, and postoperative changes were compiled and frequency analyzed. A nonparametric Wilcoxon test for paired variables was performed to contrast significant differences between pre- and postoperative quality of life related to hyperhidrosis and its complications. RESULTS: The therapeutic success rate was 100%. Complications were seen in 14.2% of the cases and included hemothorax in two, hemopneumothorax in three, pleural hemorrhage in two, and minimal apical airspace in nine. Of the 106 patients who were monitored over a period of 6 to 12 months through follow-up interviews and questionnaires, 67% developed compensatory sweating, 95% reported improvement in quality of life, and 4% experienced no change in quality of life, mainly because of the emergence of compensatory sweating. Of the patients interviewed, 97.2% said that they would undergo the operation again. CONCLUSION: Video-assisted thoracoscopic sympathectomy for the treatment of primary palmar hyperhidrosis is effective, with low rates of morbidity and no mortality. Despite the appearance of postoperative changes such as compensatory sweating, patient satisfaction with the procedure is high and their quality of life improves.

[Usefulness of video-assisted thoracoscopy for the diagnosis of solitary pulmonary nodules]. / Utilidad de la cirugía videotoracoscópica en el diagnóstico de los nódulos pulmonares solitarios.

OBJECTIVES: Various approaches are used for the diagnosis and treatment of solitary pulmonary nodules (SPN) of unknown origin. New imaging techniques and nuclear medicine have provided more information about SPN, but surgical removal is still the most sensitive and specific way to obtain a correct analysis of the lesion. With video-assisted thoracic surgery (VATS), a histological diagnosis can be obtained without resorting to thoracotomy. In the present study we describe our experience with the diagnosis and treatment of SPN using VATS. MATERIAL AND METHODS: From July 1992 through April 2001, 182 patients were operated on for SPN in our department. DESIGN: Retrospective study. Mean age: 59.2 years (12-78). Sex: 39 women and 143 men. Localization: Visual or instrumental exploration in 102 patients, with palpation in 52 cases and using a hookwire guided by preoperative computed tomography in 25 (with failure in 4 of those cases). Tissue was biopsied during surgery and when the lesion was malignant, oncological excision was performed during the same operation. RESULTS: A firm diagnosis was obtained by VATS for 178 patients (98.3%). For three other patients the surgeon had to take a needle biopsy (Tru-cut) during surgery, and in one case conversion to open surgery was necessary. Histopathology: hamartoma: 11; fibrous nodule: 10; bronchiolitis obliterans: 1; pneumoconiosis: 1; mesenchymal tumor: 3; inflammatory pseudotumor: 14; mucormycosis: 1; tuberculoma:17; lymphoma: 1; carcinoid tumor: 6; metastasis: 22; bronchogenic carcinoma: 95. Mortality was 0.55%, with 1 patient dying from massive pulmonary thromboembolism. Morbidity was 5%, from 9 minor complications. CONCLUSIONS: VATS is an effective approach, with low morbidity and mortality. We consider it to be the technique of choice for the diagnosis of all SPN and for the treatment of some, such as benign nodules and solitary metastases.

Extramuscular soft tissue myxoma of the lateral neck.

Myxomas are rare benign connective tissue tumours of unclear histogenesis. In this case a lateral neck tumour initially behaved, both clinically and radiographically as a lipoma, and was therefore managed conservatively. Subsequently the lesion caused pressure symptoms and therefore a surgical approach was taken with subsequent histology confirming a myxoma. Only five cases of soft tissue myxoma of the lateral neck have been reported in the English literature of which two were extramuscular. This is the largest reported myxoma of the head and neck region and was treated with simple enucleation. There has been no evidence of recurrence five years after surgery.

[Videocardioscopy: a new way to assess resectability of cT4 lung cancer by vascular invasion]. / Videopericardioscopia: una nueva exploración para valorar la resecabilidad de los cánceres de pulmón cT4 por invasión vascular.

OBJECTIVES: To demonstrate the usefulness of intrapericardial inspection of pulmonary vessels by video assisted thoracoscopy (VAT), for determining whether suspicion indicated by computed axial tomography (CAT) or magnetic resonance (MR) scanning is justified or not. PATIENTS AND METHOD: Since 1993 we have used exploratory VAT for final staging and assessment of lung cancer resectability. Intrapericardial vascular exploration (IVE) is a complementary method of assessing resectability in cT4 cases. We have performed 20 IVE among 460 VAT when intrapericardial involvement of pulmonary vessels has been suspected (19 men, 1 woman, mean age 64.6 years, range 50-77). VAT demonstrated invasion for 11 patients with previous suspicion based on hilar and vascular invasion shown by CAT scan; in 9 others such involvement was found during IVE for assessing resectability. VAT-IVE was performed through three or sometimes four entrance approaches, from which intrapericardial vessels were explored easily. RESULTS: Five cases were non-resectable: four due to invasion of the pulmonary artery to its point of origin and one due to extensive invasion of pulmonary veins and the left auricle. The remaining 15 cases were resectable and lesions were removed by posterolateral thoracotomy with intrapericardial dissection and ligature of the vessels. Five had been considered non-resectable by teams at other hospitals where they were classified as advanced cT4 cancers after imaging. The mean duration of IVE was 23 minutes (range 16 to 33); mean postprocedural stay was 48 h in non-resected patients, who were sent for neoadjuvant therapy on the third day. These patients, who underwent only IVE, had no complications and there were no deaths, with five unnecessary thoracotomies avoided. CONCLUSIONS: IVE allows correct staging of the T parameter in patients for whom T4 classification is suspected, avoiding unnecessary thoracotomies in non-resectable cases and allowing for surgical removal in cases where CAT or MR imaging results are unclear.

[The treatment of myasthenia gravis by video thoracoscopic thymectomy. The technic and the initial results]. / Tratamiento de la miastenia grave mediante timectomía videotoracoscópica. Técnica y resultados iniciales.

The primary role of thymectomy for the treatment of myasthenia gravis is currently undisputed. Traditionally, the approach of choice has been sternotomy, although a transcervical route has also been advocated because of its lower rate of associated morbidity. Our department performed thymectomy using a video-assisted thoracoscopic technique in 7 patients (2 men and 5 women) between March 1993 and October 1995. The patients' mean age was 43.4 years (range 20 to 66 years). Complications were few, consisting of 2 cases of pneumothorax due to contralateral opening of the pleura, resolved by pleural drainage. No deaths occurred. Clinical results over periods of observation ranging from 14 to 44 months were excellent in 2 cases of complete remission; good in 3 patients with considerable reduction in drug requirements; and fair in 2 patients who continued to need the same doses of medication throughout the 14 months after thymectomy. The technique we propose is less aggressive than mid-sternotomy, offering incontrovertible advantages and leading to faster. No patient required assisted ventilation for longer than 4 hours and the maximum time spent in the intensive care unit was 24 hours. We therefore suggest that thymectomy to treat myasthenia gravis be performed by thoracoscopy.

Comparative retrospective study of surgical treatment of spontaneous pneumothorax. Thoracotomy vs thoracoscopy.

BACKGROUND: Since May 1992 we have used video-assisted thoracic surgery (VATS) for the treatment of the spontaneous pneumothorax. In this study we review the results obtained with this technique and we compare them with those obtained by conventional surgery (1976-1992). METHODS: 110 patients (98 males and 12 females, age 15-83 years) were operated by VATS, and 627 patients (567 males and 60 females, age 14-89 years) by conventional surgery. The surgical technique and the complications are compared. No one died. RESULTS: Although the number of complications was greater in the first group than in the second one (29.5% vs 15.1%), this is attributed to the lack of experience among surgeons in the first cases; which complications nearly disappeared in the last 60 patients. Less pain, better recovery, and shorter hospital stay resulted. CONCLUSIONS: For us VATS is the ideal technique with which to treat spontaneous pneumothorax.

The use of videoassisted thoracic surgery in lung cancer: evaluation of resectability in 296 patients and 71 pulmonary exeresis with radical lymphadenectomy.

OBJECTIVE: To outline the usefulness of videothoracoscopic and videoassisted surgery in the final staging, resectability evaluation and treatment of lung cancer, and its possible advantages over thoracotomy. PATIENTS AND METHOD: Videothoracoscopy was performed on 296 patients suffering from lung cancer. Patient selection criteria are described, as well as techniques for the different kinds of resections. Postoperative care and patient follow-up is also detailed. RESULTS: Of the 296 patients 189 were operated on by open surgery after final staging and resectability evaluation. A total of 30 were considered unresectable by videothoracoscopic exploration, five cases needed exploratory thoracotomy to determine the resectability and in the remaining 72 cases the pulmonary resection was performed by videoassisted surgery: 21 pneumonectomies, five bilobectomies and 46 lobectomies. Three patients were rescued for surgery, after it was proven by intrapericardical videothoracoscopic exploration that the pulmonary artery was free at this level. The mean hospital stay was 48 h for the videothoracoscopic exploration and 6.8 days for the major lung resections. There were ten patients with complications (14%). The perioperatory mortality (30 days) was three cases (4.2%). The outcome (3-40 months follow-up) at the end of the study period was 62% patients alive and free of disease. DISCUSSION: The applications of videothoracoscopic and videoassisted surgery in the treatment of lung cancer are considered: final staging, resectability evaluation, nodule biopsy and major resections with mediastinal lymphadenectomy. Their advantages include minimized pain, better cosmetic results, a shorter hospital stay and fewer complications.