Background: Every passing day brings new innovations to medical science and Thoracic Surgery is no exception to it. We have witnessed gradual evolution in VATS from multiple ports to single port over the last two decades. Objective: To evaluate whether this evolution is worth in terms of minimizing the postoperative complication. Study Design: Prospective randomized observational trial.

Background: Hyperhidrosis is bilateral, symmetrical and profuse sweating beyond physiological limits of the body. It is an important disease that causes social and emotional disturbances. Conservative treatment has poor results and most of the patients end up in surgical remedy eventually. The choice of operation is Bilateral Sympathectomy which has excellent results. Objective: The aim of this study was to assess the demographic features of patients and to evaluate the outcome of VATS Sympathectomy. Study Design: Prospective Study. Setting: Aseer Central Hospital, Saudi Arabia. Period: September 2017 to March 2020. Material & Methods: Bilateral VATS with resection of sympathetic chain from T2 to T5 was done depending upon the area involved in hyperhidrosis. Results: 28 (58.3%) male and 20(41.6%) female patients with mean age 21 years (range 19 to 53) were documented. 40% of the patients related their condition to be familial. Most common site of involvement was combined Palmer Plant and Axillary in 26(54%) whereas isolated facial hyperhidrosis was the least involved area. Complication rate was 12% with no mortality recorded. Excellent results with 98% patient’s satisfaction was found. Conclusion: Bilateral VATS sympathectomy is the gold standard surgical treatment for Primary Hyperhidrosis with excellent results.

Introduction Post-operative spinal cerebrospinal fluid (CSF) leaks are a common and potentially serious surgical complication. The management of intra- and post-operative leaks is heterogeneous. Numerous studies advocate for dural repair and CSF diversion. The LiquoGuard7 allows automated and precise CSF pressure and volume control, with the calculation of patient-specific biometrics. We sought to summarize our experience with patient-specific CSF automated drainage with layered spinal wound closure. Methods This single-centre case series included patients undergoing complex spinal surgery where: 1) a high-flow intra- and/or postoperative CSF leak was expected and 2) concurrent CSF diversion was performed via lumbar drain attached to a LiquoGuard7®. CSF diversion was tailored to calculated CSF production rates and other case factors to maintain a neutral pressure across the operative site. Results Three patients were included, with a variety of pathologies (T7/T8 disc prolapse; T8-T9; T4-T5 metastatic spinal cord compression). The first two patients underwent CSF diversion to prevent post-op CSF leak, whilst case 3 required this in response to post-op CSF leak. CSF hyperproduction (140-150ml/hr) was evident in all cases. With patient-specific CSF diversion regimes, no cases required further intervention for CSF fistulae repair (including for pleural CSF effusion), wound breakdown or infection. Conclusion Automated patient-specific cerebrospinal fluid drainage may have a role in the closure of complex spinal wounds with high-flow CSF leaks, with a smaller risk profile than traditional manual drainage. Further larger studies are needed to explore the comparative benefits and cost-effectiveness of these devices.