Thoracic endoscopic surgery for hyperhidrosis: comparison of different techniques.

BACKGROUND: Hyperhidrosis is pathological perspiration in palmar, plantar or axillary surfaces. Video-assisted thoracic surgery (VATS) is currently the most commonly used therapy for hyperhidrosis. Blockage of sympathetic ganglia is achieved by segmental resection, transection and/or cauterization, and clipping of the chain. We aimed to compare the efficacy of these methods with respect to patient satisfaction, recurrence of symptoms and complications. METHODS: Eighty male patients with a mean age of 22.02 +/- 2.61 years undergoing bilateral thoracoscopic sympathectomy or sympathetic blockage to treat primary hyperhidrosis were included in this randomized study. The patients were divided into four groups depending on the technique used for sympathetic blockage; techniques included resection (n = 20), transection (n = 20), ablation (n = 20), and clipping (n = 20). RESULTS: The primary success rate for isolated palmar hyperhidrosis was 96.3 %; for palmar and axillary hydrosis it was 95.7 % and for palmar and face/scalp hyperhidrosis it was 66.7 %. No recurrence was observed. The overall success rate of the operation was 95 % and the differences between the four groups were not statistically significant. In the clipping group, the duration of the surgical procedure was significantly shorter than in the other groups. Complication rates were similar among the groups. The postoperative chest roentgenogram revealed pneumothorax in nine patients, but none of them required intervention. CONCLUSION: Thoracic endoscopic sympathetic blockage yields similar results irrespective of the surgical technique adopted.

Results of endocardial radiofrequency ablation of atrial fibrillation during mitral valve surgery.

AIM: The aim of the study is to evaluate the efficacy of thermocontrolled endocardial radiofrequency (RF) ablation for the patients with mitral valve disorder and associated chronic atrial fibrillation during mitral valve replacement operation. METHODS: Between February 2002 and January 2004, 43 patients with mitral valve disease and associated chronic atrial fibrillation underwent mitral valve replacement and thermocontrolled endocardial RF ablation with Cobra RF system flexible probe at Gulhane Military Academy of Medicine, Department of Cardiovascular Surgery. Eighteen of the patients (41.8%) were males, while the remaining 25 (58.2%) were females. The average age of the patients was 44+/-14.21 (18-66) years. Functional capacity of the patients was class II in 15 (34. 9%), class III in 24 (55.8%), class IV in 4 (9.3%) according to the NYHA classification. At the preoperative period all of the patients were evaluated routinely by twelve-lead ECG, chest film and transthoracic echocardiography (TTE). For the patients over 40 years of age, we performed additional coronary angiography to delineate any coronary lesions. The patients were evaluated at months 1, 3, 6 and annually by twelve-lead ECG, TTE and holter monitoring after discharge. RESULTS: There were not any complications related to the performed technique. No operative and hospital mortality were recorded. At the follow-up period for 35 of 43 patients (81.4%) sinus rhythm was restored. The mean follow-up time was 24.3+/-11.2 (12-35) months. CONCLUSION: Endocardial RF ablation especially during mitral valve surgery is a simple technique to be performed. Early and midterm results of the cohort are satisfying.