2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
lumen general endotracheal anesthesia was used in all
patients. One hundred (100) patients were retrospectively
reviewed during the same time period in 2003 who had a T3 or
T3,4 sympathecotomy.
Results: Fifty-two (52) patients had cutting at the T3 level (17
men, 35 women). Ages ranged from 16 to 60 years with age of
26. No patient experienced a Horner?s syndrome and no
patient was prescribed medication for CS. Forty-eight (48)
patients had clamping at the T3 level ( 20 men, 28 women).
Ages ranged from 15 to 51 years with a mean of 26. No patient
experienced a Horner?s syndrome and 3 patients were prescribed
glycopyrrolate (Robinul) for CS. One patient in the
clamping group experienced mild recurrent palmar sweating.
All patients were discharged on the same day as surgery and
none required readmission for pneumothorax , pain or bleeding.
Conclusion: It is concluded that cutting or clamping at the T3
sympathetic ganglion level is a safe and effective treatment for
palmar hyperhidrosis. It may further diminish the risk of
Horner?s syndrome and perhaps decrease the severity of
Compensatory Sweating. It is further postulated that removing
the clamp within 3 months of surgery may reverse the CS side
effect if it is debilitating but cause a recurrence of hyperhidrosis.
P418–Thoracoscopy
TRANSCERVICAL MEDIASTINAL LYMPH NODE DISSECTION
FOR ESOPHAGEAL CANCER, E Fitzsullivan, M Maish,R
Cameron, Department of Surgery, UCLA Medical Center
Introduction: The lymph node drainage of the esophagus is
complex. Obtaining these lymph nodes for the purposes of
staging or local control in esophageal cancer can be challenging
and requires a three field operation: neck, chest and
abdomen. A thoracotomy can be done to obtain the lymph
nodes in the chest but it is invasive and morbid. We propose
that extended mediastinoscopy can be used to obtain the thoracic
lymph nodes that are involved in esophageal cancer,
using a less morbid, minimally invasive technique.
Method: 10 patients with esophageal cancer were identified.
Each patient underwent a preoperative staging work-up that
included a CT scan of the chest and abdomen, a PET scan, an
EGD, and an EUS. All patients underwent a transcervical mediastinal
lymph node dissection using a mediastinoscope and, if
necessary, a rigid esophagoscope. Nodal tissue in stations 2R,
2L, 4R, 4L, 8R, 8L, 5, 6 and 7 were visualized and completely
resected. 8 patients underwent esophagectomy. In two
patients, lymph node metastases were found in the paratracheal
region, and these patients were sent for definitive
chemoradiotherapy. All specimens were sent to pathology for
routine examination.
Results: There were 7 women and 3 men. The median age was
65. 8 patients underwent neoadjuvant chemoradiotherapy. A
mean of 31 lymph nodes per patient were resected. Three
patients had postoperative pulmonary complications that
resolved with aggressive respiratory therapy and antibiotics.
All patients went to the floor postoperatively and none
required a stay in the ICU. The median length of stay was 7
days. There were no intraoperative complications or deaths.
Conclusions: A transcervical mediastinal lymph node dissection
is a minimally invasive procedure that is safe and effective.
Patients may avoid a thoracotomy and a lengthy hospital
stay. Lymph nodes from all thoracic stations can be obtained
with minimal risk to the patient. This nodal information may
aid in preoperative staging and guide multi-modality therapy
for patients with esophageal cancer.
P419–Thoracoscopy
VIDEO-ASSISTED SEGMENTAL RESECTION FOR LUNG
TUMORS WITH COMPUTED TOMOGRAPHY GUIDED LOCAL-
IZATION., Masahide Murasugi PhD, Toyohide Ikeda
PhD,Takuma Kikkawa MD,Naoko Wachi MD,Toshihide Shimizu
PhD,Kunihiro Oyama PhD,Masahiro Mae PhD,Takamasa Onuki
PhD, First Department of Surgery, Tokyo Women?fs Medical
University, Tokyo, Japan
BACKGROUD: Although video-assisted thoracic surgery (VATS)
is now widely accepted. However, VATS procedure is seldom
used for pulmonary segmental resection.
METHODS: Between 1987 and 2003, 455 patients underwent
video-assisted thoracic surgery for primary lung cancers or
metastatic lung tumors at the Tokyo Women?fs Medical
University. Among then, 27 patients underwent VATS segmental
resection because of tumor location, there population consisted
of 18 males and 9 females with a mean age of
66.2(range, 27 to 82).
RESULTS: VATS was carried out with three surgical ports and
small thoracotomy. Simultaneous segmental resection was
performed with basic operation, and anatomical segmental
resection was performed in 4 cases. Median operation time
was 272 minutes and average blood loss was 219 mL. We performed
preoperative computed tomography-guided localization
of lung tumors with use of a hook wire needle. Two cases
were performed two point CT guided hook wire marking for
excision line. Resected segment was S6 (n=18), S8 (n=3), S7
(n=2), S2 (n=1), S4 (n=1), S5 (n=1), S7 (n=1) and S9 (n=1).
There was no surgical mortality.
CONCLUSIONS: This report demonstrates that preoperative
CT-guided localization can facilitate safe VATS segmental
resection of a small deep pulmonary nodule. VATS segmental
resection is safe and may be an acceptable for lung tumors.
P420–Thoracoscopy
THORACOSCOPIC LINGULECTOMY IN AN IMMUNOCOMPRO-
MISED PATIENT WITH PULMONARY ASPERGILLOSIS, Bryan A
Whitson MD, Michael A Maddaus MD,Rafael S Andrade MD,
Division of General Thoracic Surgery, University of Minnesota
Department of Surgery
INTRODUCTION ? Invasive Pulmonary Aspergillosis (IPA) has a
very high mortality in the immunocompromised patient. The
mainstay of treatment is medical therapy, however, surgical
resection has a therapeutic role in selected cases. When resection
is performed, lung preservation is attempted, usually
resulting in simple wedge resection. Occasionally, larger
lesions, or those deeper within the parenchyma, may require
anatomic resection such as lobectomy or segmentectomy.
Although thoracoscopic lobectomy is described, thoracoscopic
anatomic segmentectomy for localized IPA has not been
reported. We present a case of thoracoscopic lingulectomy for
localized IPA in an immunocompromised patient resistant to
medical treatment.
METHODS AND PROCEDURES ? A 66 year old male with acute
myeloid leukemia presented with progression of symptoms
from localized IPA that was resistant to optimal medical therapy.
Computerized tomography showed a 4.7 cm x 5.2 cm centrally
located lingular mass. Three ports and a 6 cm access
incision were used similar to that of thoracoscopic lobectomy.
Sequential dissection and transection of the lingular vein,
bronchus, and arteries was performed. The lung parenchyma
was then transected with endoscopic staplers along the lines
of inflation demarcation. Blood loss was 100cc. Pathology
showed a 4.5 cm mass with IPA and clear margins. The patient
had an uneventful recovery and was discharged on the 5th
post-operative day.
CONCLUSION ?Video assisted thoracoscopic segmentectomy,
although technically challenging, can be safely performed,
allowing the benefits of a less invasive approach with lung
sparing.
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