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Palmar hyperhidrosis

Everyone sweats – but what if you had a condition that caused uncontrollable sweating in your hands?

Palmar hyperhidrosis is a benign condition where individuals experience uncontrollable sweating of their hands, way beyond their physiological needs. Hand sweating in such a scenario is often described as being present 24/7, may be worsened in situations of stress but also occurs out of nowhere in times of total rest and serenity. From the constant dampness the hands are exposed to, ulcerations and other skin related changes may develop. Many patients with this condition adopt a line of work and a life style that minimizes public encounters and avoid hand contact such as having to shake hands.

It has been known since the 1920s that by dividing the sympathetic chain (nerve) high up inside the chest, a procedure called thoracic sympathectomy, we can make the hands stop sweating. To achieve this surgically was quite an undertaking back then. The surgical trauma was such that historically very few individuals with hyperhidrosis opted to have corrective surgery. With the development of videoscopic surgery, however, it has become possible to perform the sympathectomy with minimal trauma to the patients. In addition, the magnification provided by the optics of videoscopic surgery has made the surgery safer.

What is involved in an ETS (Endoscopic Thoracic Sympathectomy)?

Nowadays, we offer surgery under general anesthesia as a day surgical procedure (meaning most patients are expected to go home the day of surgery). Two small incisions are needed, and we preferentially place those on your sides. At Swedish, our preferred approach is to clamp the nerve by placing titanium clips on the nerve at appropriate levels. The advantage of clipping the nerve instead of removing a segment of the nerve (as we did prior to 2005) is for possible reversal of the sympathectomy in the rare instance where a patient may be unhappy with the side effects of the surgery (see below).

What results should I expect?

In our hands, ETS will render the hands dry in 99 to100% of cases ...

Let it snow

Have you been outside enjoying this weekend's snow fall?. Whether or not you were able to play outside, we thought we'd share some new videos in our robotic surgery series that don't require going out in the cold..and might give you inspiration of a craft project to do with your kids.

In Seattle, we can make a snowman:

And not only can our robots (driven by our robotic surgeons)
fold paper airplanes, but they can also make a snowflake:

It may be your first robotic knee surgery...

....but at Swedish, it's definitely not ours.

If you have advanced arthritis in part of your knee, robotic-assisted surgery is a great way to go. The incision is smaller. Recovery time is faster. And the surgery is more accurate for better knee function down the road.

So where should you go? Well, Swedish was the first in the Puget Sound area to perform MAKOplasty for partial knee replacements, and we’ve done more of them than any hospital in the region.

Come learn more from a Swedish orthopedic surgeon at one of our seminars, and take the first step toward a pain-free life. Or, watch the below video to see highlights from a partial knee replacement procedure:

FREE ROBOTIC KNEE SURGERY SEMINAR

Call 206-386-2502 or register online at www.swedish.org/classes
Wednesday, Jan. 18, 6–8 p.m. OR Thursday, Feb. 16, 6–8 p.m.
Swedish Orthopedic Institute 601 Broadway, Seattle
(Corner of Broadway and Cherry St. – Hourly parking available under the building)

Using robotic technology to improve outcomes in myasthenia gravis and thymoma

New technologies have the potential to improve patient outcomes but need to be carefully studied so that patients will maximally benefit.  Robotic thymectomy for myasthenia gravis and thymomas was introduced at Swedish in May of 2009 after careful evaluation of our outcomes with traditional sternotomy and VATS thymectomy.

One of the more challenging aspects of being a surgeon is to understand how new technologies can benefit your patients and how those technologies might become part of your practice. If you’ve watched Grey’s Anatomy, read Time magazine or the Wall Street Journal or surfed the web recently, you’ll be aware of the da Vinci surgical robot. The robot has allowed many different surgical specialties to operate in confined areas of the body with tiny instruments placed through equally small incisions thereby avoiding a larger incision. In thoracic surgery, one of the confined spaces is an area in front of the heart where a gland called the thymus resides.

Most people don’t even realize they have a thymus nor do they know it’s responsible for the development of immunity. However, for a small number of patients the thymus can be source of disease either by generating a tumor called a thymoma or by producing antibodies that block transmission of nerve impulses making the patient fatigue or weaken very quickly which is called myasthenia gravis (MG). Removing the thymus gland (thymectomy) is an important part of the treatment in both diseases.

Traditionally, thymectomy is accomplished ...

Best seats in the house…or in this case, the OR

If you’ve ever wanted to sit in the gallery of Grey’s Anatomy and watch a surgery, we have something for you that’s a little more powerful. On Friday, we invite you to tune in to a livestream of a procedure that changes patients’ lives.

On Friday, Dec. 16, 2011 from 9 a.m. to 12 p.m. (PST), Drs. Ron Young and Ryder Gwinn, surgeons from the Swedish Neuroscience Institute, will host a livestream on this page to discuss the affects of Essential Tremor (ET), the Deep Brain Stimulation (DBS) surgical procedure used to treat ET and the other innovative treatment options for ET available at Swedish and throughout the country.

ET is a progressive neurological condition that causes a rhythmic trembling of the hands, head, voice, legs or trunk. It is often confused with Parkinson’s disease and is often un-diagnosed.

The livestream will feature a video stream of a recorded DBS surgical procedure performed at Swedish, accompanied by a live web chat led by Drs. Young and Gwinn. The DBS device is like a pacemaker for the brain. During the surgery, a tiny wire is implanted in the area of the brain that controls abnormal movement. This wire modifies the brain’s electrical signals to help control tremors and other abnormal movements.

It gets better

Not only will you have a front seat (from the comfort of home or wherever your mobile device is) to see a life-changing surgical procedure, but you can also ask questions live to our surgeons about the surgery, essential tremor, and any other related questions you may have (like what is Gamma Knife?). And, we’ll have patients who will share their stories about the procedure and how it has changed their lives – for the better.

Tune in on Friday

You can watch the livestream ...

Surgical precision and painted pumpkins

Forget 'will it blend' - you should be asking, can my robot paint a pumpkin? (It can!)

Dr. Kristen Austin, OB/GYN (obstetrics and gynecology) physician at Swedish/Issaquah paints a Jack-O-Lantern on a miniature pumpkin using the da Vinci robot to demonstrate how this device gives surgeons greater surgical precision and dexterity over existing approaches.


If you've been wondering what the setup looks like in the OR, here are a few behind the scenes photo from our video shoot:

Lung Cancer staging

What stage is my cancer, doc?

This is often the first question we get asked when meeting with a patient newly diagnosed with lung cancer. In this blog, I would like to briefly review the notion of lung cancer staging and its implications.

Staging allows us to define the extent of a cancer and determine its best available treatment. It also allows us to statistically estimate the prognosis of the cancer. Finally, adequate staging allows us to group patients with cancers of similar extent across different institutions or even countries and evaluate the efficacy of the treatment strategies and compare with new ones.

Staging can be clinical or pathological. Clinical staging is based on the information we obtain from X-rays and scans as well as from procedures where samples (biopsies) of different tissues are obtained in an effort determine what structures may be involved with the cancer. Pathological staging is only available when the cancer has been removed by surgery: i.e. when the pathologist has measured the size of the tumor, its extent and whether or not any lymph nodes were involved with cancer. One should be aware that pathological and clinical stagings don’t always concord 100%. Sometimes clinical staging under-evaluates how extensive the cancer may be, and at times it over-evaluates it, particularly when clinical staging is based only on X-ray information. This is particularly true with the evaluation of lymph nodes that drain the area where the cancer has come from. The role of your lung cancer surgeon in adequately gathering that information to develop the best treatment plan cannot be emphasized enough.

The system we use to define a stage is called the TNM system.

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