PREOPERATIVE DIAGNOSIS: Bilateral severe primary focal hyperhidrosis – palmar and pedal.
POSTOPERATIVE DIAGNOSIS: Bilateral severe primary focal hyperhidrosis – palmar and pedal.
PROCEDURES PERFORMED:
1. Right endoscopic transthoracic sympathetic chain clipping at 3rd rib.
2. Left endoscopic transthoracic sympathetic chain clipping at 3rd rib.
SURGEON: John Doe, MD
THORACIC SURGEON: Jane Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None.
POSTOPERATIVE CONDITION: In the PACU, the patient was noted to be in stable condition. She was awake and following commands bilaterally. Her hands were warm and dry.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old Hispanic female who presented to the office in referral for treatment of severe palmar and pedal hyperhidrosis refractory to nonsurgical treatments. The risks and benefits of surgery were discussed with the patient and her parents at length. They accepted and understood all potential risks, complications and limitations of surgery, including pneumothorax, Horner’s syndrome, recurrence of the problem, compensatory sweating, failure to correct the problem, bleeding and even death, among others. After considering their options, the patient and her parents decided they wanted to proceed with surgery and came into the hospital today for that purpose.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, and general endotracheal anesthesia was induced. She was given a gram of Ancef for infection prophylaxis. She was placed in a left lateral position, and the right side of the chest was prepped and draped in routine manner. Dr. Jane Doe performed the thoracoscopic approach using two 5 mm ports in the infra-axillary region. The sympathetic chain was identified. Based on the venous anatomy, the best place for clipping of the sympathetic chain was noted to be just above the 3rd rib. The sympathetic chain was dissected out from under the parietal pleura.
Using MRI compatible endoscopic clips, three clips were applied across the sympathetic chain. The lung was reinflated, and a small chest tube was placed to remove the intrathoracic air. The chest tube was removed after several Valsalva maneuvers had been performed. The incisions were closed with 2-0 Vicryl and PDS with Dermabond.
The patient was then turned to the right lateral position, and an identical procedure was performed on the left side. Local anesthesia was used and similarly two 5 mm ports were inserted. The sympathetic chain was clipped just above the 3rd rib on the left side as well. Four MRI compatible clips were applied.
The patient tolerated the procedure well and was extubated in the operating room and taken to the PACU in stable condition. It was noted that the temperature in both hands increased after the clipping. The estimated blood loss was minimal. Sponge and needle counts were correct.
SUMMARY: The patient underwent a right endoscopic transthoracic sympathetic chain clipping just above the 3rd rib followed by left endoscopic transthoracic sympathetic chain clipping, also just above the 3rd rib.
