Video-assisted Thoracoscopic Sympathectomy for the Treatment of Facial Blushing: Ultrasonic Scalpel Versus Diathermy

• Published in: Archivos de bronconeumología (English ed.) 2004, Vol.40 (1), p.17-19
• Main Authors: Callejas, M.A., Rubio, M., Iglesias, M., Belda, J., Canalís, E., Catalán, M., Gimferrer, J.M.
• Format: Article
• Language: English
• Subjects: Bisturí ultrasónico; Facial blushing; Rubor facial; Simpaticotomía y simpaticólisis torácica por videotoracoscopia; Ultrasonic scalpel; Video-assisted thoracoscopic sympathectomy and sympatholysis
• ISSN: 1579-2129; 1579-2129
• DOI: 10.1016/S1579-2129(06)60186-9

To evaluate the advantages of the ultrasonic scalpel compared to electrocoagulation in patients undergoing video-assisted thoracoscopic sympatholysis or sympathectomy for uncontrolled facial blushing. Two hundred bilateral video-assisted thoracoscopic procedures to interrupt transmission in the thoracic sympathetic nerve were performed in 100 patients with incapacitating facial blushing. In 2 cases, the video-assisted approach was chosen because of pleural symphysis. The mean age of patients was 34 years (range: 15 to 67). The sympathetic chain was interrupted from the lower portion of the first thoracic ganglion through the third. All patients were discharged within 24 hours with the exception of one on whom an emergency thoracotomy had been performed. No complications were reported in the group in which a harmonic scalpel was used. One case of temporary Horner syndrome (4 months) and 3 cases of persistent chest pain (more than 2 weeks) were reported in the diathermy group. There were 9 cases of partial and asymptomatic pneumothorax that resolved without treatment or prolonged hospital stays. Dissection of the sympathetic nerve is accomplished more reliably and with better visualization with the ultrasonic scalpel. Peripheral lesions in lung parenchyma and adjacent tissues (intercostal vessels and nerves) are avoided, as is Horner syndrome, which can be caused by dispersion of heat. Use of the ultrasonic scalpel would also lead to a lower incidence of postoperative neuralgia. Valorar las ventajas de la utilización del bisturí ultrasónico frente a la electrocoagulación, en los pacientes operados de rubor facial incontrolable mediante simpaticólisis o simpaticotomía torácica por videotoracoscopia. Se han realizado 200 interrupciones del simpático torácico bilaterales por videotoracoscopia en 100 pacientes afectados de rubor facial invalidante. Dos de ellas se realizaron mediante cirugía videoasistida por presentar sínfisis pleural. La edad media de los pacientes fue de 34 años (rango: 15-67). La cadena simpática fue interrumpida desde la porción inferior de T1 hasta T3 inclusives. Todos los pacientes fueron dados de alta en 24 h, a excepción del paciente en el que se realizó toracotomía de asistencia. En el grupo en que se utilizó el bisturí armónico no hubo complicaciones. En el grupo de diatermia hubo un caso de síndrome de Horner transitorio (4 meses) y tres casos de dolor torácico persistente (superior a dos semanas). En total, hubo 9 neumotórax parcela