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Right or left first during bilateral thoracoscopy?

Meera Kharbanda1, Arun Prasad, Ashish Malik

  • 1Department of Anesthesia, Apollo Hospital, E 348, Greater Kailash Part One, New Delhi 110048, India.

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|February 14, 2013
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Performing a left capnothorax first during bilateral endoscopic thoracic sympathectomy (ETS) for hyperhidrosis leads to significant hypotension. The study recommends a right capnothorax first approach for improved hemodynamic stability.

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Area of Science:

  • Thoracic surgery
  • Anesthesiology
  • Cardiovascular physiology

Background:

  • Endoscopic thoracic sympathectomy (ETS) is a surgical treatment for palmar hyperhidrosis.
  • The procedure involves bilateral division of the thoracic sympathetic chain under general anesthesia.
  • Lung collapse is typically achieved using carbon dioxide insufflation.

Purpose of the Study:

  • To compare hemodynamic changes between left-first and right-first capnothorax approaches in bilateral ETS.
  • To evaluate the impact of surgical approach order on patient hemodynamics during ETS.

Main Methods:

  • Forty American Society of Anesthesiologists grade I patients (18-30 years) undergoing bilateral ETS were randomized into two groups.
  • Group L (n=20) had left capnothorax first, followed by right; Group R (n=20) had right capnothorax first, followed by left.
  • Cardiovascular variables were monitored continuously, and statistical analysis used independent-sample t test and Pearson's chi-square test.

Main Results:

  • A significant mean percentage decrease in systolic and diastolic blood pressure was observed in the left-first (Group L) compared to the right-first (Group R) approach (P < 0.05).
  • Seven patients in Group L experienced bradycardia, though this was not statistically significant.

Conclusions:

  • The left capnothorax first approach in bilateral ETS is associated with significant hypotension compared to the right-first approach.
  • A right capnothorax first strategy is recommended for bilateral ETS to maintain hemodynamic stability.