Comparison of ultrasonic scalpel to electrocautery in patients undergoing endoscopic thoracic sympathectomy

Beyond single-use: a systematic review of environmental, economic, and clinical impacts of endoscopic surgical instrumentation

BACKGROUND

The evolution of endoscopic surgery has introduced a multitude of instruments, available in both disposable and reusable variants, influencing practices across various surgical specialties. Instrument selection is complex, considering individual preferences and institutional factors such as costs, instrument performance, and factors related to cleaning and sterilization. Notably, environmental sustainability has gained prominence due to the threat of climate change. This review assessed the existing literature to facilitate evidence-informed decision-making, encompassing clinical and economic efficacy, environmental friendliness, and other important criteria.

MATERIALS AND METHODS

Following PRISMA guidelines, searches were conducted in Pubmed, Embase, Web of Science, and The Cochrane Library for studies comparing the environmental impact, costs, instrument performance, and contamination risk of disposable versus reusable instruments or new versus reprocessed disposables in endoscopic surgery. Life-Cycle Assessments (LCAs) were included to quantify the climate impact. Exclusions included veterinary studies, general endoscopic procedures, and novel instruments.

CONCLUSION

The search yielded 15 809 studies, 53 studies meeting the inclusion criteria: 38 compared disposable versus reusable instruments and 15 examined new versus reprocessed disposables. Reusables and/or reprocessed disposables showed favorable environmental and economic outcomes compared to new disposables. Instrument performance was comparable between the two groups. No studies were identified that investigated the clinical implications of contamination risk of disposables versus reusables. Six studies evaluating the contamination risk of reusables and reprocessed disposables showed residual pollution after cleaning and sterilization, although data on clinical outcome lacked.

INTERPRETATION

This review underscores the environmental benefits of reusables and favors both reusable and reprocessed disposables for their economic advantages. The lack of clear evidence favoring one type over the other in instrument performance necessitates further research. Addressing contamination risks requires additional studies on the clinical impact of residual substances. Future research should report outcomes on environmental sustainability, costs, instrument performance, and contamination risk.

Hyperhidrosis: A targeted literature review of the disease burden

Hyperhidrosis is a chronic skin condition characterized by excessive sweating. It poses a burden on affected people, reducing their quality of life and productivity. We undertook a targeted literature review (TLR) to gather current evidence on the epidemiology as well as the human and economic burden posed on patients with hyperhidrosis. Searches were performed in Medline database (access via OVID interface) and ICHUSHI database. Articles published between January 2000 and September 2020 that analyzed at least 50 patients were included. Sixty-four publications were identified and 38 publications covering a unique domain were selected to inform this TLR. The incidence of hyperhidrosis ranged from 0.13% in the UK to 0.28% in the USA, with a higher rate in females. The prevalence of hyperhidrosis varied from 2.8%-4.8% in the US general population to 18.40% in Chinese inpatients, while the prevalence of axillary hyperhidrosis varied from 1.4% in the US general population to 5.75% in Japanese employees/students. Due to excessive sweating, hyperhidrosis was reported to be a moderate-to-extreme limitation at work for the US patients, with 33.5% feeling unhappy. Patients' satisfaction was high post-treatment. Considerable costs were related to the treatment with botulinum toxin and surgery. Hospital stays for surgery lasted from 10 h to 3 days. The percentage of patients who sought a medical consultation varied from 6.3% for Japanese patients with primary focal hyperhidrosis to 51% for the US general population with any type of hyperhidrosis. There is limited evidence of the hyperhidrosis burden, particularly among Japanese patients; however, the burden was high and limited patients' daily functioning. Future actions should include implementation of educational programs to raise awareness of the condition, conduct of larger studies, and generation of more evidence. Understanding the nature of hyperhidrosis and the burden it poses is of utmost importance.

Analysis of engagement between ethics and return-to-work discourses in respective academic literature

BACKGROUND

Return-to-work (RTW)/back-to-work (BTW) interventions that are designed to rehabilitate individuals impaired from fulfilling employment roles are facing challenges. Ethics discourses, including ethics theories, principles and concepts, are meant to give guidance on what one ought to do or not to do and RTW professionals could use them to respond to their challenges.

OBJECTIVE

A scoping review was performed to investigate to what extent 33 ethics concepts, theories, and principles are employed in RTW/BTW academic literature, and to what extent RTW/BTW is engaged with in ethics linked academic journals.

METHODS

Three academic databases were searched, and 147 article results were extracted from our literature review to be thematically analyzed.

RESULTS

Searches with n = 11 ethics concepts and n = 4 ethics theories generated results. The content of 20 RTW/BTW article results demonstrated conceptual engagement between RTW and ethics discourses. Only one article in ethics-related journals conceptually engaged with RTW/BTW.

CONCLUSION

Ethics theories and principles were not used extensively in RTW/BTW academic literature and RTW/BTW is a topic under-engaged within ethics-related journals. Our findings indicate opportunities for further research, like conducting interviews, to better understand our findings and how to respond to them.

Electric vs. harmonic scalpel in treatment of primary focal hyperhidrosis with thoracoscopic sympathectomy

BACKGROUND

Hyperhidrosis is defined as excessive sweating beyond the physiologic needs of a person. Palmar hyperhidrosis in the adolescent period may have an impact on school work and may cause psychological problems. Thoracoscopic sympathectomy is now used routinely to treat patients with disabling primary hyperhidrosis or facial blushing.

PATIENTS AND METHODS

From January 2008 to December of 2009 bilateral thoracoscopic sympathectomy Th2-Th4 was performed to 79 patients aged from 17 to 55, who suffered from palmar, axillar or craniofacial hyperhidrosis. For the first 39 patients (group A) thoracoscopic sympathectomy was performed using electric scalpel and for the next 40 patients (group B) thoracoscopic sympathectomy was performed using harmonic scalpel.

RESULTS

Based on our results we did not find any significant differences between electric or harmonic scalpel usages for thoracoscopic sympathectomy. Moreover, there was no significant difference between complications and the severity of pain, with slightly higher intensity of pain with harmonic scalpel usage. Both electric and harmonic scalpel provided adequate treatment for primary hyperhidrosis, with the fact that non-disposable electric scalpel costs were less than that of the disposable harmonic scalpel.

CONCLUSIONS

Sympathectomy should be preferred for palmar hyperhidrosis treatment, as it is much technically shorter, simpler to implement, and also easier to learn. Thoracoscopic sympathectomy is safe and effective for the treatment of primary palmar hyperhidrosis in the adolescent period without any major side effects.

3-year follow-up after uniportal thoracoscopic sympathicotomy for hyperhidrosis: undesirable side effects

OBJECTIVE

Endoscopic thoracic sympathectomy or sympathicotomy, for the treatment of palmar, axillary, and plantar hyperhidrosis, is generally performed at one or two levels, between T2 and T5. Compensatory sweating (CS) is a severe and undesirable side effect of this procedure. Here, we describe the success of treatment and degree of postoperative CS in sympathicotomy patients.

SUBJECTS AND METHODS

This study included 80 patients treated by uniportal (5-mm) thoracoscopic sympathicotomy (electrocautery) for primary hyperhidrosis over a 6-year period (2007-2013). Sympathicotomy was performed bilaterally at T2 for blushing (n=2), T2-T3 for palmar-only hyperhidrosis (n=34), T2-T4 for palmar and axillary hyperhidrosis (n=39), and T3-T4 for axillary-only hyperhidrosis (n=5). Outcome was assessed 2 weeks postsurgery at the clinic and annually thereafter by telephone questionnaire. Mean follow-up time was 35.2±23.3 months. Questionnaires assessed patients' degree of sweating, postoperative CS, overall satisfaction, and complications.

RESULTS

Seventy-one patients (88.7%) were very satisfied, whereas only 9 (11.3%) were dissatisfied with the procedure. Complication incidence was 7.5%, and CS occurred in 77.5% of patients. Therapeutic success rate was 97.5%; complete relief of hyperhidrosis was achieved in 72 (90%) patients, whereas 8 (10%) experienced recurrence.

CONCLUSIONS

CS is a frequent side effect of thoracoscopic sympathicotomy. We recommend all patients undergoing this procedure should be warned of the potential risk of developing severe CS.