Clinical Application Of Tubeless Videoassisted Thoracoscopic Surgery For Primary Palmar Hyperhidrosis

Objective:Under the influence of the advanced concept of enhanced recovery after surgery,the clinical application value of tubeless video-assisted thoracoscopy for the treatment of primary palmar hyperhidrosis(PPH)and its safety and feasibility are discussed.Methods:The clinical data of 46 patients who underwent bilateral endoscopic thoracic sympathectomy(ETS)in the Department of Thoracic Surgery at the First Hospital of Lanzhou University during the time period from March 2017 to September2020 were collected.Data from the clinical data of the included patients were analyzed retrospectively,among them,22 patients who underwent tubeless video-assisted thoracoscopic surgery for bilateral thoracic sympathectomy,10 males and 12 females,with a mean age of(24.3±6.4)years,were set up as Tubeless group.Twenty-four patients,13 males and 11 females,with a mean age of(23.5±4.8)years,underwent conventional thoracoscopic-assisted bilateral thoracic sympathectomy and were set as the control group.Tubeless group was treated with tubeless treatment and thoracoscopic-assisted bilateral thoracic sympathectomy was performed by the same group of experienced thoracic surgeons in both groups.Tubeless group used laryngeal mask or mask ventilation intravenous general anesthesia,and prepared double-lumen tracheal tube,single-lumen tracheal tube,tracheal blocker,which can be converted to tracheal intubation to improve the patient’s ventilation in case of sudden intraoperative emergency,the chest drain was removed after the surgery was completed and the negative chest pressure was established with good lung resuscitation,and no catheter was left in place intraoperatively or postoperatively.In the control group,general anesthesia with double-lumen tracheal intubation was used,and 8Fr ultra-fine chest drains were left in the chest cavity bilaterally after surgery and urinary catheters were routinely left in the postoperative period.The perioperative data of the patients were collected,and the general data,operation time,anesthesia effect,postoperative recovery index,postoperative pain assessment score,incidence of postoperative complications,length of hospital stay and subjective patient satisfaction and other observation indexes of the two groups were compared and analyzed to study the differences between the two groups.Postoperative follow-up was conducted through outpatient,telephone and We Chat contacts.Results : All patients were successfully completed thoracoscopically assisted bilateral thoracic sympathectomy by the same group of surgeons,and no emergency situation such as intraoperative ventilation obstruction requiring conversion to tracheal intubation occurred in the Tubeless group,and all patients did not have life-threatening situations requiring intermediate chest opening.Tubeless group compared with the control group,their anesthesia resuscitation time [(14.4±1.6)min vs.(20.1±1.8)min,P=0.000],time to get out of bed on the first postoperative day [(3.1±0.6)h vs.(1.6±0.4)h,P=0.000],postoperative hospital stay [(1.7±0.5)d vs.(2.8±0.6)d,P=0.000],postoperative pain visual analog score [(1.4±0.6)vs.(3.4±1.1),P =0.000],and postoperative patient satisfaction [95.4%(21/22)vs.66.7%(16/24),P=0.037] were significantly better than the control group in terms of observation.There were no statistically significant differences in age,smoking history,gender,hand sweating and concomitant sites,and hand sweating classification between the two groups(P > 0.05);there were no statistically significant differences in clinical observations such as total operative time,intraoperative blood loss,special postoperative complications compensatory hyperhidrosis(mild),and common postoperative complications between the two groups(P > 0.05).Conclusion: Intraoperative and postoperative reductions in the use of invasive tubing can significantly affect the speed of postoperative recovery in patients with hand sweats,and the reduction in invasive trauma makes postoperative pain management easier,thereby enhancing patient satisfaction with the procedure.From the comparison of using different surgical modalities to treat primary palmar hyperhidrosis,tubeless video-assisted minimally invasive thoracic surgery has its unique advantages.Compared with traditional thoracoscopic surgery or open-chest surgery,its strict access mechanism and the application of standardized procedures make the method safe and controllable,less traumatic,and faster postoperative recovery,which is in line with the concept of accelerated rehabilitation surgical treatment.