Tag Archives: sympathectomy

Thoracic surgery and sympathectomy

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Clinica Palermo,

Dr. Luis Torres, thoracic surgeon

I went back to see Dr. Luis Torres, thoracic surgeon and spent the day in the operating room with him for a couple of cases.   He is a very pleasant, and friendly surgeon that I interviewed last week.  Dr. Torres just recently returned to Bogotá after training in Rio de Janeiro for the last several years at the Universidade de Estado de Rio de Janeiro.  He completed both his general surgery residency and thoracic surgery residency in Rio after graduating from the University de la Sabana in Chia, Colombia.  (He is fluent in Spanish and Portuguese).

I spent some time out in Chia last year with the Dean of the medical school (and thoracic surgeon, Dr. Camilo Osorio).

The first case was a sympathectomy for hyperhidrosis.  I’ve written more about the surgical procedure over at Examiner.com, and I will be posting more information about the procedure – potential candidates and alternative treatments over at the sister site.

 

The second case was more traditional thoracic surgery – a wedge resection for lung biopsy in a patient with lung nodules.  **

In both instances, cases were reviewed prior to surgery, (films reviewed when applicable – ie. second case) and visibly posted in the operating room.  Patients were sterilely prepped, draped and positioned with surgeon present.  Anesthesia was in attendance for both procedures – and hemodynamic instability/ desaturations (if present) were rapidly attended/ addressed / corrected.

Dr. Torres utilized a dual-port technique for the sympathectomy, making 1 cm incisions, and using 5mm ports.  Each side (bilateral procedure) was treated rapidly – with the entire procedure from initial skin incision and application of final bandaids taking just 35 minutes.

Dr. Torres, performing VATS

The second case, proceeded equally smoothly, and without complications.  There was no significant bleeding, hypoxia or other problems in either case.  Surgical sterility was maintained.

** Both patients were exceedingly gracious and gave permission for me to present their cases, photographs etc.

Just as the second case ended – Dr. Ricardo Buitrago arrived – and performed a sympathectomy on one of his patients – using a single-port approach.  (I am currently working on a short YouTube film demonstrating both of these techniques.)

In the operating room with Dr. Mauricio Palaez, thoracic surgeon

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Clinica del Country,

Caught up with Dr. Palaez one evening to accompany him to the operating room. As we previously mentioned, he is completing his vascular surgery fellowship this fall, and is a busy fellow indeed.  He has an upcoming trip to Barcelona, Spain for two months training in endovascular surgery prior to completing his fellowship this Nov/Dec.

When I caught up to him, Dr. Palaez was seeing consulting in the emergency room prior to heading to the operating room for a bilateral sympathectomy.

In the operating room,  all standard time out, and pre-operative protocols were followed.  Anesthesia in attendance with good heart rate control – and appropriate hemodynamics, no hypoxia.

Case completed quickly, surgical sterility maintained. No intra-operative issues.

Surgical apgar score 10 at completion of case.

Thoracic surgery, Operation Smile, and a new perspective in Chia

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Spent the morning in Chia with Dr. Osorio (thoracic surgeon) at Clinica Universitario Teleton.  Cases went smoothly, beautifully and quickly. Then we rounded on patients in another facility..


While I was in Chia, I had an opportunity to meet several members of Fundacion Operacion Sonrisa (Operation Smile to all my stateside readers).  I spoke with Pilar, one of the nurses on the surgical team, and Dr. Celso Bohorquez Escobar, plastic surgeon, who said they have sixteen cases planned for this weekend.  They come to Chia several times a year, and operate in multiple locations throughout Colombia.  For any of you unfamiliar with this organization (consisting of volunteer doctors, nurses and other medical staff), Operation Smile performs cosmetic repairs of facial deformities such as cleft palate for indigent patients and their families.

I also had a chance to (briefly) meet two urologists from Medellin that traveled to Chia to perform a urinary continence restoring surgery. I particularly like to see this sort of thing, (bringing care to patients in rural areas, or those who would otherwise go without) – because while neither of these procedures is arguably lifesaving, both procedures are dramatically life-altering, and contribute greatly to the enhancement of quality of life.

But, back to Dr. Osorio – I especially enjoyed talking to Dr. Osorio because as the Dean of Medicine for a medical school, he has different perspectives on the future of medicine, and Colombian medicine in general. He also shows a lot of insight, and open-mindedness to outside perspectives and opinions. Part of this comes from dealing with students and residents everyday, another part may be from his partnership with another physician in Chile (Dr. Claudia Suarez) and some of it undoubtably comes from experience.

I found it interesting and illuminating that Dr. Osorio is probably the first person to ask about my observations, and perspectives on surgery and medicine in Bogota, after being here three months, meeting numerous surgeons, and visiting multiple facilities.. And he seemed to actually be interested in the answers.. I think that any doctor who takes the time to consider the insights of foreign nurse, and asks for criticisms, is someone, who takes the time to look at the world differently, (and medicine needs that.)

A day of Passion!

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Had a long, but exciting day, with some interesting doctors – who are strikingly passionate about their work, which is always wonderful to see.

This morning, I traveled out to Chia, to the University of Sabana to visit with Dr. Camilo Osorio Barker, MD who is the Dean of Medicine, (and a practicing thoracic surgeon.)  Like many thoracic surgeons here in Colombia, Dr. Osorio practices at several locations, (primarily out in Chia at the University-affiliated hospital) but he also sees patients at Cardioinfantil. (He is partnered with Dr. Tellez and Dr. Garzon, both of whom we’ve interviewed previously)

One three- day weekend a month, he sees patients in Medellin.  He primarily specializes in the treatment of hyperhidrosis (excess sweating of palms, facial flushing) by thorascopic sympathectomy.  He report that this makes up about 90% of his practice – with the remainder of cases as VATS lung resections, and other lung procedures.    There’s a lot more to tell – but it’s been a long day, and I have an early appointment tomorrow with Dr. Ramon (neurosurgery) at Hospital Centro de Policia..

Don’t worry – I will be seeing Dr. Osorio again soon.

Next stop was Dr. Fernando Hakim, a neurosurgeon at Santa Fe de Bogota.  He was a fantastic interview – while he does the whole spectrum of neurosurgical procedures for vascular malformations, tumors, spinal problems, etc, he is best known for his treatment of normal pressure hydrocephalus (NPH).

(As I mentioned in a previous post) It seems almost inevitable, or inescapable that the son of the famed Dr. Salomon Hakim (who developed the first treatment for normal pressure hydrocephalus) – has carried on his father’s legacy. But Dr. Fernando Hakim is passionate about neurosurgery, and has certainly made his mark..

He clearly loves his work – I could have interviewed him for hours, and hours (but he’s a busy neurosurgeon, so I didn’t).  I will be seeing him again soon – (next week) and I’ll bring more information then.

Lastly, I stopped in to see Dr. Jose Felix Castro, general surgeon for a quick visit to get some last minute information for another project I am working on..