2005 SAGES Abstracts

POSTER ABSTRACTS
stay period was 1.5 days (range 1-3 days). Wound infection
developed in two patients with Cushing?s syndrome. There
was no mortality. Histopathological exam of specimens
revealed a cortex adenoma in 16 cases (10 of which was nonfunctional),a
pheochromocytoma in 4, a bilateral cortical
hyperplasia and a lymphoma in case each.
Conclusion:
Laparoscopic adrenalectomy is an established method in the
treatment of adrenal masses. The performance of laparoscopic
adrenalectomy as well as of other laparoscopic procedures has
become easier with the introduction new energy system,
LigaSure. In fact, vascular control and dissection of the gland
by LigaSure reduces the blood loss almost to nil and shortens
significantly the operation period. Laparoscopic adrenalectomy
by the use of LigaSure is an easy,safe and reproducible procedure.
P414–Solid Organ Removal
RADIOFREQUENCY ABLATION FOR PARTIAL LAP SPLENEC-
TOMY. AN EXPERIMENTAL STUDY., DIMITRIS ZACHAROUIS
MD, KONSTANTINOS TEPETES MD,GEORGE TZOVARAS
MD,ANTIGONI POYLTSIDIS MD,KONSTANTINOS
HATZITHEOPHILOY, Department of Surgery. University
Hospital, University of Thessaly,Larisa,Greece.
Introduction
Partial Splenectomy is performed infrequently by either the
laparoscopic or the open approach. The most common indications
include trauma, hamartomas, diagnosis and treatment of
non-parasitic cyst and staging of Hodgkin disease. In this
experimental study the radiofrequency ablation (RFA) probe
(Radionics / Tyco Hellas) has been used laparoscopically for
division of the splenic parenchyma.
Material and Methods
In the surgical experimental lab, 5 pigs underwent lap partial
splenectomy (LPS) under general anesthesia. The three trocar
technique, as in laparoscopic splenectomy were used. Two
applications of the RFA probe were enough to create a zone of
desiccation approximately 1cm from the splenic hilum. The
division of the splenic parenchyma was carried out using scissors.
The specimen was removed using an endobag. The animals
then underwent exploratory laparotomy.
Results
No blood loss was recorded during the splenic parenchyma
division. The medium operating time was 30min. (range 25-
35). There were no obvious thermal injuries to the adjacent tissues.
Conclusions
The RFA probe can be used successfully for LPS in pigs. There
was no blood loss and no thermal injury. The RFA looks promising
as another tool for hemostasis and bloodless splenic
resection.
P415–Thoracoscopy
FIFTY-TWO CONSECUTIVE THORACOSCOPIC SYMPATHEC-
TOMIES FOR PALMARIS HYPERHIDROSIS OR COMPLEX
REGIONAL PAIN SYNDROME, Justin M Burns MD, B Todd
Heniford MD,Nicholas H Tinkham BA,Michael A Cowan
MD,Craig A Van Der Veer MD,Kent W Kercher MD,Brent D
Matthews MD, Carolinas Medical Center
Introduction: The purpose of this study is to evaluate the efficacy
and outcomes of consecutive thoracoscopic sympathectomies.
The indication for the procedure was either palmaris
hyperhidrosis (PH) or complex regional pain syndrome (CRPS).
Methods: Patients undergoing thoracoscopic sympathectomy
between July 1998 and June 2004 were identified. Medical
records were reviewed and standard descriptive statistics were
performed.
Results: There were a total of 50 patients that received 52
operations (two patients had a contra lateral sympathectomy
performed as a second procedure). Patients had a mean age of
29 years (M:F 20:30). Forty-eight procedures were performed
for PH while 4 were for CRPS. The mean operating time was
78 minutes; mean blood loss, 50cc; and mean postoperative
stay, 1.1 days. Forty-five procedures were performed for bilateral
disease (87%). Nine patients developed a unilateral pneumothorax.
Eight required tube thoracostomy (removed after
1.25 days) while 1 patient received percutaneous evacuation.
One patient developed a chest wall hematoma at a trocar site
that resolved spontaneously and one patient developed a transient
Horner?s syndrome. After a mean follow-up of 5.3
months, 59% (27/46) of patients treated for hyperhidrosis
reported compensatory sweating. Forty-six (92%) patients
(both PH and CRPS) were satisfied with their outcome. Four
patients were dissatisfied due to excessive compensatory
sweating. Three patients (75%) treated for CRPS were asymptomatic
although all four patients reported satisfaction from
the procedure.
Conclusion: Thoracoscopic sympathectomy is a safe and effective
alternative treatment for PH and CRPS. Compensatory
sweating occurred in >50% of patients although the majority of
patients were satisfied with their short-term outcome.
P416–Thoracoscopy
CASE REPORT: MEDIASTINITIS AND EMPYEMA ARISING
FROM INFECTED PANCREATIC PSEUDOCYST SUCCESSFULLY
TREATED BY VATS, Yi-Chen Chang MD, Department of
Surgery, Far Eastern Memorial Hospital
CASE REPORT: MEDIASTINITIS AND EMPYEMA ARISING
FROM INFECTED PANCREATIC PSEUDOCYST SUCCESSFULLY
TREATED BY VATS
Yi-Chen Chang, Li-Ming Tseng, Min-Shi Wang*
Surgical Department, Division of Gastroenterology*, Medical
Department
Far Eastern Memory Hospital, Taipei, Taiwan
Objective: Mediastinitis is a life threatening disease.
Treatments include antibiotics treatment and adequate draiage.
Traditionally, thoracotomy is necessary for drainage of
mediastinitis extending below carina. As the advance of VATS,
thoracoscopic surgery can achieve adequate drainage of mediastinum.
Methods: Common causes of acute mediastinitis include surgical
infection, esophagus rupture, descending infection from
oral pharynx. Ascending infection from pancrease to mediastinum
is rare. Anatomically, the retroperitoneum space can
communicate to the posterior mediastinum. However, the
most common thoracic complications of acute pancreatitis are
pleural effusion or empyema, and frank mediastinitis is very
rare. We reported a case of 41 year-old male who was sent to
our hospital because of chest pain, dyspnea and fever. Chest X
ray showed widening of mediastinum and bilateral pleural
effusion. Pleural tapping showed purulent pleural effusion and
high level of amylase. Chest CT was done and showed
enlarged paraesophagus tissue. Besides, a cyst at pancreatic
tail with cephald extension was noted. Esophagogram did not
showed perforation of esophagus. Surgical intervention was
arranged under the impression of acute mediastinitis and
empyema. The operation was approached by VATS from right
side. We clear the pleural cavity and then open the mediastinal
pleura. Pus and necrotic tissue at paraesophagus area were
debrided. Chest tubes at pleural cavity were placed after operation.
NPO for one week was prescribed after operation.
Antibiotics treatment continued for 2 weeks. Postoperative
course was uneventful and follow-up chest CT one month later
showed complete resolution of medistinitis. However, the pancreatic
pseudocyst did not resolve.
Conclusion: VATS can achieve adequate drainage of mediastinitis.
P417–Thoracoscopy
ENDOSCOPIC TRANSTHORACIC SYMPATHECOTOMY FOR
PALMAR HYPERHIDROSIS, David S Edelman MD, Mariner’s
Hospital, Tavenier, Florida
Intro: Endoscopic Transthoracic Sympathecotomy (ETS) has
been shown to be an effective treatment for palmar hyperhidrosis.
Compensatory Sweating (CS), although usually mild,
is a side effect that occurs in 100% of patients. CS is the reason
for regretting having the operation in 2% of patients operated
upon. Horner?s syndrome is another common side effect
if operating at the T2 ganglion level of the sympathetic chain.
Methods: Beginning March, 2002 I began offering a T3 clamping
of the sympathetic chain as an alternative to a T3 cutting
sympathecotomy for palmar hyperhidrosis. Some patients had
an additional T4 sympathecotomy for axillary sweating. The
surgeon had an experience of over 700 ETS operations. Single
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