Assessment of the learning curve of video-assisted thoracoscopic sympathectomy in a single neurosurgical trainee: a cumulative summation analysis

Background Video-assisted thoracoscopic sympathectomy (VATS) is a common procedure unusually practiced by neurosurgeons due to lack of training. Objective To evaluate the learning curve for VATS in a young neurosurgeon with no previous experience in open sympathectomy techniques or extracranial endoscopic procedures. Methods This is a retrospective review and analysis of prospectively collected data in 50 consecutive cases admitted to our facility with the diagnosis of essential palmar and axillary hyperhidrosis operated by a neurosurgical trainee under strict supervision of 2 experienced mentors. After an initial training phase, cumulative sum mation (CUSUM) analysis was used to evaluate the surgical performance of the trainee in terms of operating time, blood loss, hospital stay and failures. Results Improvement in operating time was noticed after the first 20 cases with significant affection by changes in OR team. The blood loss was significantly improved after the first 10 cases with less sensitivity to changes in OR team. Hospital stay and failures were steady and within expected values throughout the study. Conclusion An average of 20 cases may be enough for a neurosurgeon with basal knowledge to attain technical competence in VATS sympathectomy. Mentored surgical training on VATS sympathectomy is a safe and effective training method with failures within expected limits. The experience of the OR team plays an important role in the rapid improvement and consistency of performance.

Efficacy and Safety of Radiofrequency Ablation Versus Video-assisted Thoracoscopic Sympathectomy in Palmar Hyperhidrosis: A Multicenter Cohort Study

Background: Radiofrequency ablation (RFA) was adopted as an alternative to surgical options for sympathectomy in patients with palmar hyperhidrosis (PHH), but the RFA comparative efficacy of treatments by video-assisted thoracoscopic sympathectomy (VATS) on long-term remains uncertain.Methods: We recruited patients aged ≥14 years with diagnosed PHH from 14 centers in China. The treatment options of RFA or VATS were recruited in patient with informed consent. The primary outcome was the clinical efficacy in 1-year. Propensity scoring and multivariable models respectively were used to evaluate the clinical efficacy and inefficacy risk of treatment options.Results: A total of 807 patients were enrolled, 351 patients underwent RFA, and 456 were VATS. After propensity score matching, the rate of complete remission was lower in RFA than in VATS (79.2% [247/312] versus 91.3% [285/312], 95% confidence intervals [CI] 0.21 to 0.57, p<0.001). However, the rate of palmar dryness (95% CI 0.38 to 0.92, p=0.020), of postoperative pain (95% CI 0.13 to 0.33, p<0.001), and of surgical-related complication (95% CI 0.19 to 0.85, p=0.020) is lower in RFA group than in VATS group, and radiofrequency ablation group of skin temperature rise is more common (95% CI 1.84 to 3.58, p<0.001).Conclusion: Performing RFA had a lower success rate than VATS for the complete remission of palmar hyperhidrosis. However, RFA may be better reasonable treatment option for palmar hyperhidrosis before surgical sympathectomy, because it more possibly accepted and generalized due to lower symptomatic burden and costs than surgical sympathectomy in patients.Trial RegistrationChiCTR2000039576, URL: http://www.chictr.org.cn/index.aspx

The Effect of T3 versus T4 Thoracoscopic Sympathectomy on Hyperhidrosis

Background: Primary hyperhidrosis is a disorder characterized by excessive sweating. However, surgical therapy is the most effective treatment for patients with primary hyperhidrosis. In between all different surgical approaches, video assisted thoracoscopic surgery (VATS) sympathectomy has been considered as a safe and minimally invasive procedure for palmer and axillary hyperhidrosis. The aim of this study was to evaluate the effectiveness of T3 vs. T4 sympathectomy regarding postoperative complications, recurrence and compensatory hyperhidrosis (CH) on 6 months follow up. Methods: This prospective randomized study was conducted over 20 patients undergoing VATS sympathectomy diagnosed with palmar hyperhidrosis and failed medical treatment and undergoing thoracoscopic sympathectomy. Patients were divided randomly into two groups; group A (T3 sympathectomy) and group B (T4 sympathectomy). Results: There was no significant difference between the two groups regarding the degree of treatment success, compensatory hyperhidrosis after one month and after 6 months. There was non-significant difference between the two groups regarding the recurrence, late postoperative complications and satisfaction. Conclusions: Video-assisted T3 or T4 sympathectomy is a safe and effective procedure for treatment of palmar hyperhidrosis and T3 or T4 sympathectomy had no difference regarding to dryness and Compensatory Hyperhidrosis in follow-up for 6 months. Both techniques were effective for treating palmar hyperhidrosis with high rates of success and no recurrence for 6 months.

SURGICAL TREATMENT IN RAYNAUD'S DISEASE

INTRODUCTION In primary or refractory cases of Raynaud's Disease (RD), with severe symptoms (pain, ulcers, and disability), minimally invasive surgical treatments such as thoracoscopic sympathectomy have recently been proposed. The objective of this study will be to evaluate the viability, feasibility and results of this therapeutic option in this type of patient. MATERIAL AND METHODS Descriptive prospective study from January 2017 to January 2019 where all patients with a diagnosis of RD, with poor clinical control and disability, and refractory to medical treatment are collected. RESULTS Seven girls (9-15 years old) were collected. All underwent bilateral thoracoscopic sympathectomy, T2-T4, with a mean surgical time of 55 min. No need for pleural drainage. All of them were discharged before 36 hours after surgery (12-36 hours) without any immediate intra or postoperative complications. All reported an immediate postoperative period without incident, without new episodes of pain or intense vasoconstriction. However, 6 months after surgery, 3 of the 7 (42.85%) presented partial reappearance of the symptoms. However, the 7 presented 100% satisfaction with the surgical results. CONCLUSIONS There are currently very few published studies regarding this surgical option. We believe that our series is the first pediatric series to be collected, although it is very limited. However, the results obtained to date, in global terms, are encouraging. We consider that thoracoscopic sympathectomy is a feasible and safe surgical technique to consider in patients with RD refractory to conservative treatment.