Fast track endoscopic thoracic sympathicotomy

Abstract.

The length of hospital stay is an important factor of cost and psychological discomfort in the treatment of hyperhidrosis by endoscopic thoracic sympathicotomy (ETS). Our experience enrolls 1587 patients operated on an outpatient basis in the last 10 years and seven months. This study aimed to confirm that ETS can be performed on an outpatient basis. Fifty-two consecutive patients (30 males and 22 females) were submitted to ETS under general anesthesia using a single lumen endotracheal tube, with lung collapse by intrapleural injection of CO₂. The sympathetic chain and the communicating rami were severed at different levels according to hyperhidrosis location. Patients were physical state American Society of Anesthesiologists 1 and 2. Age varied between 13 and 55 years (27.3 ± 10.2 years). They were monitored with ECG, SPO2, NIBP, expired CO₂, sevoflurane analyzer, and airway pressure. Normal saline (40.0 ± 2.7 ml/kg) was infused intravenously. The drugs used were propofol, alfentanil, rocuronium, ondansetron, dexamethasone, dipyrone, cetoprofene and sevoflurane. Anesthesia and post-operative data were analyzed. Post-operative thoracic X-rays were taken in 20 patients before discharge. Anesthesia lasted 67.2 ± 20.8 minutes, and the surgical procedure took 46.3 ± 20.9 minutes. The patients stayed 18.0 ± 11.0 minutes in the post-anaesthetic care unit and were discharged from hospital after 150.3 ± 43.1 minutes. The only abnormal post-operative event observed was insignificant residual carbothorax, found in 2 (10%) of the thoracic X-rays taken. In conclusion, this study confirmed that ETS can be performed safely on an outpatient basis.