PMID- 30994925
OWN - NLM
STAT- MEDLINE
DCOM- 20200424
LR  - 20200424
IS  - 1424-3997 (Electronic)
IS  - 0036-7672 (Linking)
VI  - 149
DP  - 2019 Apr 8
TI  - Establishing a non-intubated thoracoscopic surgery programme for bilateral 
      uniportal sympathectomy.
PG  - w20064
LID - Swiss Med Wkly. 2019;149:w20064 [pii]
LID - 10.4414/smw.2019.20064 [doi]
AB  - 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 NiVATS 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.
FAU - Caviezel, Claudio
AU  - Caviezel C
AD  - Department of Thoracic Surgery, University Hospital Zurich, Switzerland.
FAU - Schuepbach, Rolf
AU  - Schuepbach R
AD  - Institute of Anaesthesiology, University Hospital Zurich, Switzerland.
FAU - Grande, Bastian
AU  - Grande B
AD  - Institute of Anaesthesiology, University Hospital Zurich, Switzerland.
FAU - Opitz, Isabelle
AU  - Opitz I
AD  - Department of Thoracic Surgery, University Hospital Zurich, Switzerland.
FAU - Zalunardo, Marco
AU  - Zalunardo M
AD  - Institute of Anaesthesiology, University Hospital Zurich, Switzerland.
FAU - Weder, Walter
AU  - Weder W
AD  - Department of Thoracic Surgery, University Hospital Zurich, Switzerland.
FAU - Hillinger, Sven
AU  - Hillinger S
AD  - Department of Thoracic Surgery, University Hospital Zurich, Switzerland.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20190417
PL  - Switzerland
TA  - Swiss Med Wkly
JT  - Swiss medical weekly
JID - 100970884
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Anesthesia, General/methods/statistics & numerical data
MH  - Female
MH  - Humans
MH  - Hyperhidrosis/*surgery
MH  - Intubation/methods/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Operative Time
MH  - Sympathectomy/methods/*statistics & numerical data
MH  - Thoracic Surgery, Video-Assisted/*statistics & numerical data
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2019/04/18 06:00
MHDA- 2020/04/25 06:00
CRDT- 2019/04/18 06:00
PHST- 2019/04/18 06:00 [entrez]
PHST- 2019/04/18 06:00 [pubmed]
PHST- 2020/04/25 06:00 [medline]
AID - Swiss Med Wkly. 2019;149:w20064 [pii]
AID - 10.4414/smw.2019.20064 [doi]
PST - epublish
SO  - Swiss Med Wkly. 2019 Apr 17;149:w20064. doi: 10.4414/smw.2019.20064. eCollection 
      2019 Apr 8.