title: [Video-assisted thoracoscopic sympathectomy for the treatment of facial flushing: ultrasonic scalpel versus diathermy].
abstract: OBJECTIVE
  To evaluate the advantages of the ultrasonic scalpel compared to electrocoagulation in patients undergoing video-assisted thoracoscopic sympatholysis or sympathectomy for uncontrolled facial blushing.
  
  
  METHODS
  Two hundred bilateral video-assisted thoracoscopic procedures to interrupt transmission in the thoracic sympathetic nerve were performed in 100 patients with incapacitating facial blushing. In 2 cases, the video-assisted approach was chosen because of pleural symphysis. The mean age of patients was 34 years (range: 15 to 67). The sympathetic chain was interrupted from the lower portion of the first thoracic ganglion through the third.
  
  
  RESULTS
  All patients were discharged within 24 hours with the exception of one on whom an emergency thoracotomy had been performed. No complications were reported in the group in which a harmonic scalpel was used. One case of temporary Horner syndrome (4 months) and 3 cases of persistent chest pain (more than 2 weeks) were reported in the diathermy group. There were 9 cases of partial and asymptomatic pneumothorax that resolved without treatment or prolonged hospital stays.
  
  
  CONCLUSIONS
  Dissection of the sympathetic nerve is accomplished more reliably and with better visualization with the ultrasonic scalpel. Peripheral lesions in lung parenchyma and adjacent tissues (intercostal vessels and nerves) are avoided, as is Horner syndrome, which can be caused by dispersion of heat. Use of the ultrasonic scalpel would also lead to a lower incidence of postoperative neuralgia.
authors.affiliation: Servei de Cirurgia Toràcica, Institut Clínic de Pneumologia i Cirurgia Toràcica, Hospital Clínic i Universitari, Barcelona, Spain. 7891mcp@comb.es
authors.forename: M A
authors.initials: MA
authors.lastname: Callejas
authors.forename: M
authors.initials: M
authors.lastname: Rubio
authors.forename: M
authors.initials: M
authors.lastname: Iglesias
authors.forename: J
authors.initials: J
authors.lastname: Belda
authors.forename: E
authors.initials: E
authors.lastname: Canalís
authors.forename: M
authors.initials: M
authors.lastname: Catalán
authors.forename: J M
authors.initials: JM
authors.lastname: Gimferrer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001821:Blushing / Q000502:physiology; D003972:Diathermy / Q000379:methods*; D005260:Female; D005483:Flushing / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013562:Sympathectomy / Q000295:instrumentation / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*