Establishing a non-intubated thoracoscopic surgery programme for bilateral uniportal sympathectomy

Abstract

AIM OF THE STUDY: Non-intubated, video-assisted thoracoscopic surgery (NiVATS) has been successfully developed in several centres worldwide. Local anaesthesia techniques and techniques to perform thoracoscopic surgery on a spontaneously breathing lung are the two key elements which must be adopted to establish a NiVATS programme. We established NiVATS by performing bilateral, uniportal sympathectomies, and compared it to classical video-assisted thoracoscopic surgery (VATS) under general anaesthesia with double-lumen intubation.METHODS: Ten consecutive bilateral VATS sympathectomies were compared with ten consecutive NiVATS procedures. Nineteen of the procedures were for palmar hyperhidrosis and one was for facial blushing. Duration of anaesthesia, surgery and hospitalisation, perioperative complications, side effects and quality of life before and after sympathectomy were analysed. RESULTS: Median age was 26.5 years (range 17-55) and mean BMI in the NiVATS group was 21.8 (range 19.1-26.3). NiVATS sympathectomies were performed as outpatient procedures significantly more often (9/10 vs 3/ 10, p = 0.008). Quality of life was significantly increased after sympathectomy in all patients, with no significant differences between the NiVATS and the VATS groups. There were no differences between the two groups regarding compensatory sweating (40 vs 50%, p = 0.66). The duration of anaesthesia, not including the time required for the surgery, was significantly shorter in the Ni-VATS group (p <0.001). The duration of surgery, from the first local anaesthesia until the last skin suture, was significantly longer in the NiVATS group (p = 0.04), but showed a constant decline during the learning curve, from 95 minutes initially to 48 minutes for the last procedure. Costs were significantly lower in the NiVATS group (p = 0.04).CONCLUSION: Thoracoscopic sympathectomy is a suitable procedure with which to establish a NiVATS programme. Patients are usually young and of healthy weight, facilitating the learning curve for the local anaesthesia techniques and the surgery. Compared to VATS, sympathectomy is more likely to be performed as an outpatient procedure and has a lower cost, while safety and efficacy are maintained.

Long-term Outcomes of Endoscopic Thoracoscopic Sympathectomy for Primary Focal Palmar Hyperhidrosis: High Patient Satisfaction Rates Despite Significant Compensatory Hyperhidrosis

“…Methods that eliminate the use of general anesthesia, such as the Nonintubated video-assisted thoracoscopic surgery have been successfully developed in several centers worldwide. 29,30 These "awake" procedures are based on the use of local anesthesia and rely on techniques to perform thoracoscopic surgery on a spontaneously breathing lung. These techniques have been found to be safe and effective compared with sympathectomies done under general anesthesia, with the main advantage being a quick postoperative recovery.…”

“…However, these techniques did not provide a shorter procedure duration time and required a gradual learning curve. 30,31 Another suggested practice to shorten operation time discussed in the literature is the single incision uniportal access technique. However, this method requires improved optics and specifically designed equipment that may not be available in all centers.…”

Treatment outcomes and objectification methods of the thoracoscopic sympathectomy in patients with focal hyperhidrosis and blushing syndrome

“…Однопортова відеоасистована торакоскопічна симпатектомія (ВАТС) є ефективним малоінвазивним хірургічним методом вибору лікування первинного вогнищевого гіпергідрозу, який зумовлений патологічною гіперактивністю симпатичного відділу вегетативної нервової системи [1][2][3]. Нині цей метод також широко використовують для лікування блашинг-синдрому, характерним симптомом якого є неконтрольовані часті та інтенсивні напади почервоніння шкіри обличчя та шиї [4].…”

Comparison of Intubated Versus Non-Intubated Techniques in Video-Assisted Thoracoscopic Sympathectomy

“…Caviezel ve ark. 'nın [8] çalışmasında, NIVATS Sempatektomi grubunda 10 hastadan 5'inde, VATS Sempatektomi grubunda 10 hastadan 3'ünde pnömotoraks belirlenmiştir. İlgili çalışmada rejyonal anestezi ve sedasyon altında uygulanan NIVATS'larda, hastalardan akciğer ekspansiyonu için derin nefes alması veya öksürmesi istenememiş; bu nedenle toraks içine bir sonda yerleştirilerek cerrahi aspiratör yardımıyla toraks içinde-ki havanın tahliyesi sağlanmıştır.…”

“…Uygun ÇLT seçimi ve genel anestezi yönetimi bu komplikasyonların sıklığını ve şiddetini etkileyebilir. Minör VATS prosedürlerinde ÇLT ile tek akciğer ventilasyonuna alternatif olarak NIVATS teknikler de kullanılabilir [8] . NIVATS tekniği; entübe etmeden ve hava yolu aracı kullanmadan rejyonal anestezi teknikleriyle kombine olarak uyanık ve sedasyon altında veya supraglottik hava yolu araçları ile genel anestezi altında uygulanabilir [9] .…”