‍Hyperhidrosis, or excessive sweating, is a condition that affects millions of people around the world. While it may not be life-threatening, it can still have a significant impact on a person’s quality of life. Sweaty hands, also known as palmar hyperhidrosis, is one of the most common types of hyperhidrosis. While there are several non-surgical treatments available, hyperhidrosis surgery is often the best solution for those who have tried everything else without success. In this article, I will explore the benefits of hyperhidrosis surgery in India and why it has become such a popular destination for this type of procedure. Understanding Hyperhidrosis and its Symptoms Hyperhidrosis is a medical condition that causes excessive sweating. While sweating is a natural way for the body to regulate its temperature, people with hyperhidrosis sweat even when they don’t need to. This can be embarrassing and uncomfortable, especially when it occurs on the hands, feet, face, or underarms. Sweaty hands, in particular, can make it difficult to perform everyday tasks such as writing, typing, or shaking hands with others. The symptoms of hyperhidrosis can vary from person to person, but some common signs include: The Psychological Effects of Hyperhidrosis Hyperhidrosis can have a significant impact on a person’s mental health and wellbeing. Constant sweating can lead to feelings of embarrassment, shame, and anxiety, which can affect a person’s social life, relationships, and career. People with hyperhidrosis may avoid social situations or activities that could trigger sweating, leading to isolation and loneliness. Studies have shown that people with hyperhidrosis are more likely to suffer from depression and anxiety than those without the condition. They may also experience lower self-esteem and a poorer quality of life. This is why it’s essential to seek treatment for hyperhidrosis, whether through non-surgical methods or hyperhidrosis surgery. Some detailed statistics reported in the medical literature related to the social and emotional impacts of hyperhidrosis can be read Here Non-Surgical Treatments for Hyperhidrosis Before considering hyperhidrosis surgery, non-surgical treatments should be explored. These include: While these treatments may be effective for some people, they may not work for everyone. In some cases, hyperhidrosis surgery may be the best option. Hyperhidrosis Surgery in India- What is it? Hyperhidrosis surgery, also known as Sympathectomy, is a surgical procedure that involves cutting or clamping the sympathetic nerves that control sweating. This is typically done through small incisions in the chest or armpit. The procedure can be performed under general or local anaesthesia, and patients can usually go home the same day or the next day. There are two main types of hyperhidrosis surgery: Whatever technique used, the most important aspect of the surgery is to correctly define in which level (or levels) the sympathetic trunk shall be interrupted. This decision has to be based on the patient’s symptoms localization, in balance with the risks of postoperative Compensatory Hyperhidrosis (CH). For palmar hyperhidrosis, the interruption at the R3 and R4 levels will provide the most curative scenario, marked by completely dry hands, but with a higher risk of CH. For patients who prefer a lower risk of CH at the expense of less dry hands, the interruption can be done only at R4 level. Benefits of Hyperhidrosis Surgery Hyperhidrosis surgery is a highly effective treatment for sweaty hands and other types of hyperhidrosis. Some of the benefits of surgery include: Hyperhidrosis Surgery in India – Why is it Popular? India has become a popular destination for hyperhidrosis surgery due to its high-quality medical facilities and skilled surgeons. The cost of hyperhidrosis surgery in India is also much lower than in many other countries, making it an affordable option for those who may not have access to healthcare in their home country. In addition to the lower cost, many people choose to have hyperhidrosis surgery in India because of the high level of expertise and experience of the surgeons. Many Indian doctors have trained in the US or Europe and are up to date with the latest techniques and technologies. This ensures that patients receive the best possible care and outcomes. Dr. Kamran Ali trained extensively at many centres of excellence around the world including Austria, South Korea and Japan. He is committed to providing the best surgical outcomes at par with international standards here in India.

Bronchiectasis is a debilitating lung condition that can severely affect one’s quality of life, causing recurrent infections, coughing, and shortness of breath. As a Thoracic Surgeon, I have witnessed first-hand the harmful impact this condition can have on a person’s well-being. This chronic ailment causes damage and widening of the airways in the lungs, making it arduous for them to clear secretions and mucus effectively. In this article, we will delve into what bronchiectasis is, its symptoms and causes, and the viable option of surgery for its treatment. What is Bronchiectasis? The term Bronchiectasis comes from two Greek words; “Bronkhia” and “Ektasis” meaning “Airway widening”. Bronchiectasis is a perplexing chronic condition that affects the airways in the lungs causing irreversible dilatation of the bronchial tree. It impedes the airways’ ability to clear mucus and other secretions effectively, resulting in build-up of mucus in lungs leading to recurrent lung infections, pneumonias and other complications. Bronchiectasis can be treated by medicines, surgery or a combination of both. Symptoms of Bronchiectasis Causes of Bronchiectasis Most of the cases of bronchiectasis are idiopathic in etiology However, it may be found in a variety of pulmonary diseases like: Bronchiectasis treatment options The treatment of bronchiectasis includes: Medications like antibiotics (Long-term inhaled or oral antibiotic therapy), bronchodilators and anti-inflammatory agents can ease the symptoms and prevent infections. Airway clearance techniques such as chest physiotherapy and the use of nebulizers can help in clearing mucus and secretions from the airways. Pulmonary rehabilitation, which involves breathing exercises and physical therapy, can boost lung function and enhance overall quality of life. Surgery for Bronchiectasis When is it Recommended? Surgery for bronchiectasis is usually considered when: As per the British Thoracic Surgery (BTS) guidelines, the indications of surgery for bronchiectasis include: Types of surgery for bronchiectasis The type of surgery for bronchiectasis depends on the severity and location of the damage. Lung Resections: Surgery for Bronchiectasis If the diseased area is limited to a lobe, segment or one lung, the options are – Lung Transplant: Surgery for Bronchiectasis Double Lung Transplant is an option for End-stage Bronchiectasis, where both lungs are damaged extensively. These patients have no or limited normal lung tissue to carry on the act of breathing and are progressively dependent on supplemental oxygen. Approach for Surgery for Bronchiectasis Posterolateral thoracotomy is the standard approach for pulmonary resection in patients with bronchiectasis. Preservation of the integrity of chest wall muscles using muscle-sparing technique is essential to reduce postoperative pain and generate an effective cough. When the decision is for bilateral lung resection, the second operation can be performed with an interval of 1–4 months Most lung resections for bronchiectasis can now be safely performed using Video-Assisted Thoracic Surgery (VATS), a minimally invasive procedure, in expert hands. During a video-assisted lobectomy, a surgeon makes 1 to 3 small incisions in the chest near the affected lung. A thoracoscope (camera) is inserted in one of the incisions to inspect the entire chest cavity including the lungs. The camera projects an image onto a video screen, helping to guide the surgeon during the procedure. The surgeon inserts surgical instruments through the other incisions in order to remove the lobe. Recovery After Surgery for Bronchiectasis After a lobectomy, patient remains in the hospital for several days. The doctor will prescribe pain medications to alleviate any discomfort and give supplemental oxygen until patient is able to breathe on his own. While in the hospital, pulmonary rehabilitation specialists will teach deep breathing and coughing exercises, which help to reopen airways and strengthen the lungs after surgery. It is advised to avoid lifting heavy lifting for a few weeks, as well as exposure to smoke and fumes. Conclusion Bronchiectasis is a chronic lung condition that can severely impact a person’s quality of life. While there are several treatments available, surgery is becoming an increasingly viable option for those who have exhausted other avenues. Suppose you or someone you know experiences the symptoms of bronchiectasis you can get in touch with Dr. Kamran Ali and his team for management of the same.

Myasthenia Gravis (MG) is a chronic autoimmune, neuromuscular disorder. It is characterized by muscle weakness due to an overactive immune system that attacks the body’s own muscles. MG can be debilitating and requires aggressive treatment. Thymectomy is a surgical procedure that removes the thymus gland and the fat surrounding it, which plays a role in the production of certain immune cells. Thymectomy can be an effective treatment for Myasthenia Gravis, and it offers a number of potential benefits, in carefully selected patients. What is Thymectomy? Thymectomy is a surgical procedure that involves the removal of the thymus gland. The thymus gland is a butterfly shaped organ located in the chest between the two lungs, right behind the breast bone and in front of the heart. It is part of the immune system and plays an important role in the production of certain immune cells known as T-lymphocytes. In some cases, the thymus can become enlarged or hyperactive, which can lead to MG. Removing the thymus can help reduce the symptoms of MG. Thymectomy can be performed through open surgery, Video-assisted thoracoscopic surgery (VATS), or robot-assisted thoracoscopic surgery (RATS). What is Myasthenia Gravis? Myasthenia gravis is an autoimmune disorder in which the body’s own immune system attacks and weakens the muscles. The common symptoms of MG are: There are two different forms of MG: The weakness in MG usually fluctuates throughout the day. The weakness tends to be the least in the morning after waking up and is more severe by the end of the day after prolonged usage of the involved muscle groups. It is a progressive disease in most cases marked by some time periods of remission and relapse. Less than 1/4th of MG patients will also experience a Myasthenic crisis along with severe respiratory failure. Benefits of Thymectomy in Treating Myasthenia Gravis The goals of thymectomy treatment can be different for different patients. These may include: One of the biggest benefits of thymectomy in treating myasthenia gravis is the potential to reduce symptoms and improve quality of life. Studies have shown that thymectomy can improve muscle strength, reduce fatigue, and improve breathing in MG patients. Thymectomy has also been shown to reduce the number of relapses and the need for medication. In some cases, thymectomy can even lead to a complete remission of MG symptoms. Types of Thymectomy Surgery The goal of thymectomy is to remove as much as thymic tissue possible from the standard as well as ectopic sites of thymus. This can be achieved by many different approaches. The different types of thymectomy surgery that can be used to treat MG are as follows: Who is a Good Candidate for Thymectomy in Myasthenia Gravis ? The best candidates for thymectomy are: Plasmapheresis or intravenous immunoglobulin is recommended before thymectomy in patients with preoperative respiratory or bulbar symptoms Timing of Thymectomy in Myasthenia Gravis Although each case should be assessed individually to find the best timing for surgery for that particular patient, there are certain rules which help in having a better outcome: Risks of Thymectomy Thymectomy carries some risks. These patients are not great candidates for general anaesthesia because of respiratory function impairment. The other risks are: Alternatives to Thymectomy in Myasthenia Gravis Apart from thymectomy there are three more options for treatment of Myasthenia Gravis. Conclusion Thymectomy is a surgical procedure that involves the removal of the thymus gland and can be an effective treatment for Myasthenia Gravis. It can reduce symptoms, improve quality of life, and reduce the need for medication. Thymectomy carries some risks, and it is not the right treatment for everyone. It is important to discuss all of your treatment options with your doctor before deciding if thymectomy is right for you. If you are considering thymectomy for the treatment of myasthenia gravis, you can get in touch with Dr Kamran Ali and his team, who have a vast experience in dealing with patients with MG who need surgery.

I. Introduction Let’s face it, the thought of undergoing surgery can be daunting. But what if I told you there’s a way to achieve the same results with less pain, less scarring, and a faster recovery? Enter Video Assisted Thoracoscopic Surgery (VATS). This minimally invasive procedure is taking the medical world by storm and for good reason. With VATS, doctors can access the chest cavity through small incisions instead of a large open surgery, resulting in less trauma to the body and a quicker recovery time. It’s no wonder that VATS Surgery in India is becoming the go-to option for lung cancer, pleural effusion, emphysema, pneumothorax, esophageal cancer and sympathectomy for hyperhidrosis. So, if you’re facing thoracic surgery, don’t be afraid to ask your doctor about VATS surgery, which is also known as “Keyhole chest surgery” in India. Trust me, you’ll be glad you did. II. The Advantages of VATS A. Less invasive: – VATS is considered less invasive than traditional open thoracic surgery because it uses small incisions ( two or three ) to access the chest cavity, rather than a large open incision. A camera and few long instruments enter the chest through these tiny cuts on the chest. The images are transmitted to a monitor placed in front of the surgeon. The surgeon completes the entire procedure looking at the monitor while manoeuvring his instruments in the chest cavity. This results in less trauma to the body, and less bleeding during the procedure. Not only is the incision small, but also there is no cutting of muscles and spreading of ribs. In recent times the number of small cuts have also decreased with many surgeries now possible with only one tiny incision (Uniportal VATS surgery) – According to a study published in the Journal of Thoracic Disease, patients who underwent VATS had a mean blood loss of 27.4 ml, compared to 199.4 ml for patients who underwent open thoracic surgery. B. Faster recovery time: – One of the most significant benefits of VATS surgery is the faster recovery time compared to traditional open thoracic surgery. According to a study published in the Journal of Thoracic Disease, patients who underwent VATS had a mean recovery time of 7.4 days, compared to 12.8 days for patients who underwent open thoracic surgery. This can be attributed to the smaller incisions and less tissue damage associated with VATS. Another study published in the Journal of Surgical Oncology found that patients who underwent VATS for lung cancer had a mean hospital stay of 4.1 days, compared to 7.2 days for patients who underwent open thoracic surgery. This is a significant reduction in recovery time, allowing patients to return to normal activities sooner. C. Reduced pain:     – According to a study published in the Journal of Cardiothoracic Surgery, patients who underwent VATS reported less pain and discomfort compared to those who underwent open thoracic surgery. Again this could be attributed to the smaller size of the incision, avoidance of muscle cutting and rib spreading. The intercostal nerve bundle which runs beneath each rib is also at a lower risk of damage in VATS surgery as compared to an open surgery. In open thoracotomy a rib spreader is used to separate the ribs and if the surgeon is not careful enough the intercostal nerve is likely to get damaged with the metallic spreader leading to pain as well as paraesthesias.     – The study found that the mean visual analogue scale (VAS) score for pain was 2.9 for VATS patients, compared to 4.2 for open thoracic surgery patients. D. Minimized scarring:     – Smaller incisions used in VATS surgery result in less visible scarring compared to open thoracic surgery. This can be especially important for patients who are concerned about their appearance after surgery. Not only are the incisions kept smaller but are also strategically placed on the chest so as to keep them in the bra-line for females.     – According to a study published in the Journal of Thoracic Disease, the mean length of incisions for VATS was 3.7 cm, compared to 13.2 cm for open thoracic surgery. E. Improved outcomes:     – VATS surgery has been shown to have similar or better outcomes compared to open thoracic surgery. This includes similar or better survival rates, similar or better lung function, and similar or better quality of life.     – A study in the Journal of Thoracic Disease found that the 5-year overall survival rate was similar for VATS and open thoracic surgery patients (78.5% vs. 78.9%). III. VATS Surgery in Action Testimonials from patients who have undergone VATS surgery in India IV. VATS Surgery in India for Various Thoracic Conditions A. VATS Surgery for Lung cancer: -The surgical treatment of lung cancer is anatomical resection of the part of lung having the cancer as well as removal of draining lymph nodes. This may be in the form of segmentectomy, lobectomy, bilobectomy, pneumonectomy, sleeve lobectomy etc combined with mediastinal lymph node dissection. All of these anatomical resections are possible by VATS in the hands of an experienced surgeon. A special kind of lung cancer known as Neuroendocrine tumours of the lung (Carcinoids) are also amenable to VATS or keyhole chest surgery. B. VATS Surgery for Pleural Effusion and Empyema: – VATS is an effective option for the treatment of pleural effusion or empyema, a condition in which fluid or pus builds up respectively, in the space between the lung and the chest wall. In this surgery all the fluid or pus surrounding the lung along with pus flakes or debris is evacuated which decreases the infective load from the chest. It also helps to relieve the pressure that had caused the underlying lung to collapse. Sometimes a decortication process would be required to help the lung expand by removing the thick peel that forms around the lung and entraps it. – VATS for pleural effusion and empyema offers significant improvement in the breathing and quality of life after the procedure.

Introduction Lung bullae, also known as pulmonary bullae, are air-filled spaces in the lungs that are larger than normal air sacs. Blebs are air-filled collections within the layers of the visceral pleura and are <1 cm in diameter. Bullae can be caused by conditions such as emphysema, smoking, and genetic predisposition. These spaces can become enlarged, leading to symptoms such as shortness of breath, chest pain, and fatigue, which may require VATS bullectomy or lung bulla surgery. In India, lung bullae are a prevalent condition, with estimates suggesting that up to 4% of the population may be affected. According to recent studies, lung bullae are found in about 20% of patients with chronic obstructive pulmonary disease (COPD) and about 2% of patients with asthma. One of the most common treatments for lung bullae is VATS bullectomy surgery. In this article, we will take a closer look at VATS bullectomy surgery in India, including the procedure, indications, advantages, cost, and recovery. Causes and risk factors for lung bullae Symptoms of lung bullae Diagnosis of lung bullae Treatment options for lung bullae The treatment options for lung bullae vary depending on the size and location of the bulla, and the severity of symptoms. Medical management: Medical management may include bronchodilators, corticosteroids, and oxygen therapy Surgical options: Bullectomy surgery and bulla resection are surgical options for treating lung bullae. VATS bullectomy surgery is a popular and effective minimally invasive option that involves the removal of the bulla through small incisions in the chest. VATS Bullectomy Surgery: A closer look It is important to understand that not everybody who has bullae requires surgery, and surgery is not appropriate for everyone. VATS bullectomy surgery is typically recommended for patients with large bullae that are causing symptoms. A thoracic surgeon is most likely to recommend a bullectomy for patients who: Patients who have multiple bullae throughout the lungs (diffuse disease) may not be good candidates for bullectomy because surgery may cause more damage to surrounding tissue and a lot of lung volume is lost in resection. The procedure: Video Assisted Thoracoscopic Surgery (VATS) bullectomy is a minimally invasive procedure that uses small incisions on the chest wall but needs patient to be under General Anaesthesia. The number of incisions can be one (Uniportal VATS) or two/three (Standard VATS). A camera is introduced through one of the cuts to inspect the lungs and pleural cavity. The region of lung containing the bullae is identified. A leak test is also performed to identify any other source of air leak. Surgical staplers are then used to resect the bullous component and/or the area of air leak, with a margin of healthy underlying lung. Pleurodesis: Bullectomy must always be supplemented with an additional procedure of pleurodesis. It is the process of fusing the two layers of pleura together so as to obliterate the space between the lung and the chest wall. This is very important to reduce the incidence of recurrence of pneumothorax as new bullae and blebs may form lifelong in these patients and may rupture to cause collection of air outside the lungs. Pleurodesis can be: Recovery and follow-up: Patients typically stay in the hospital for a few days after VATS bullectomy surgery and may need to avoid certain activities for a few weeks while they recover. After the procedure, the person will have one or two tubes coming from the side of their chest. These tubes attach to a machine that helps suck out air and fluid from this area of the body. Once the drainage has reduced and air leak has stopped, the surgeon will remove the chest tubes safely. Advantages and disadvantages: Advantages of VATS bullectomy surgery include a shorter recovery time, less pain, and fewer complications compared to traditional open surgery. Disadvantages include the cost of the procedure and the need for general anesthesia. Cost of VATS Bullectomy Surgery in India The cost of VATS bullectomy surgery in India can vary depending on factors such as the location of the hospital, the surgeon’s experience, and the patient’s insurance coverage. VATS Bullectomy requires the usage of surgical staplers. The number of stapler fires would depend on the size of the bulla that needs to be resected. The higher the number of fires, greater the cost of the surgery would be. Comparison with other countries: The cost of VATS bullectomy surgery in India is typically lower than in other countries. Insurance coverage: Many insurance plans cover at least a portion of the cost of VATS bullectomy surgery. Conclusion VATS bullectomy surgery is an effective and minimally invasive option for treating lung bullae in India. Patients should be well-informed about the procedure and its cost before making a decision. Early diagnosis and treatment can lead to better outcomes and improved quality of life for patients with lung bullae. You can get in touch with Dr. Kamran Ali and his team for any lung bullae related query.

Neuroendocrine tumours (NETs) of the lung are a rare type of lung cancer that arise from the cells called Kulchitzky cells of the bronchial mucosa . A few lung NETs can make high levels of hormone-like substances. If these substances are released in high amounts in the blood, the tumour is called a “functional” NET and it will cause a group of symptoms called Carcinoid Syndrome. These tumours can be benign or malignant and can cause a wide range of symptoms, depending on the location and size of the tumour, as well as the hormones that it produces. Classification NETs of the lung are classified into the following types: Clinical profile of NETs of Lung The clinical spectrum of neuroendocrine tumors (NETs) of the lung is diverse and can range from asymptomatic, indolent tumors to rapidly growing malignancies. Symptoms of NETs of the lung can include: Diagnosis Most of the time lung NETs are found unexpectedly when people have annual health check-ups or imaging tests or a medical procedure done for reasons unrelated to the tumor. If a doctor suspects this disease, they will elicit a complete medical and family history and perform a complete physical examination. Tests required to diagnose a lung NET: Pathologic findings of NETs of the lung These lesions are characterized by the presence of neuroendocrine cells (small cells with round nuclei and moderate amount of cytoplasm) arranged in a trabecular, organoid, or solid pattern. The cells may be arranged in nests, cords, or trabeculae. The degree of differentiation is an important prognostic factor for NETs, the well-differentiated tumors have better prognosis than poorly differentiated ones. Immunohistochemistry is important to establish a diagnosis of NETs of the lung, The most commonly used markers are chromogranin, synaptophysin and CD56. The Ki-67 index, which measures the proliferation rate of the tumour cells, is also used to evaluate the aggressiveness of the tumour. NETs of the lung are graded based on the degree of differentiation, the Ki-67 index, and the mitotic count. The grading system is important for prognosticating the disease and for planning treatment. Radiological features Chest radiographs: NETs appear as solitary, round or oval-shaped nodules that can be well-circumscribed or spiculated. They can also appear as multiple nodules or as a mass that can be associated with atelectasis, pleural effusion or lymphadenopathy. Computed tomography (CT) scans: NETs of the lung can have a variety of appearances, including solid, ground-glass, or cystic. They may show central or peripheral enhancement after administration of IV contrast. Carcinoid tumours appear as a spherical or ovoid nodule or mass with a well-defined and slightly lobulated border. When nonspherical, the tumour is elongated with its long axis parallel to adjacent bronchi. Calcification or ossification is seen in up to 30% of cases. Positron Emission Tomography (PET) scans: A special form of PET scan is used to evaluate NETs of Lungs. They are called DOTA-NOC PET scan that uses a radioactive tracer called Ga-68 dotatate to bind to a tumour’s somatostatin receptors. Ga-68 dotatate is injected intravenously and then patients undergo the scan. NETs of the lung tend to have a high uptake of this radiotracer, indicating increased metabolic activity. Treatment Treatment options for neuroendocrine tumours (NETs) of the lung vary depending on the stage and grade of the tumour, as well as the patient’s overall health. Surgery: Surgery is the primary treatment option for localized NETs of the lung. The goal of surgery is to remove the tumour and surrounding tissue with a healthy non diseased margin. Most localized (early stage I to II and some stage III) lung NETs require only surgery. Depending on the size and location of the tumour, different surgical procedures may be used, such as lobectomy, segmentectomy, pneumonectomy or wedge resection. The surgeon will also remove the surrounding lymph nodes. In case of a Bronchial Carcinoid a lung parenchyma preserving surgery like Sleeve Lobectomy may also be done. Endoscopic management of intraluminal Carcinoids like rigid bronchoscopic resection has also been described in literature but surgery remains the gold standard. Radiation therapy: The most common type of radiation treatment for a lung NET is called external-beam radiation therapy (EBRT). Its role is mainly palliative to relieve symptoms, such as pain, caused by cancer that has spread to other areas of the body. Chemotherapy: is most often used when the tumour has spread to other organs, is growing quickly, or is causing severe symptoms. The response to chemotherapy is not that great. Most common agents that are used are: Targeted therapy: Targeted therapy is a newer type of treatment that targets specific molecules involved in the growth and spread of cancer cells. Everolimus is the only targeted therapy approved by the FDA currently for the treatment of lung NETs. Peptide receptor radionuclide therapy (PRRT): This treatment uses a small amount of radioactive material that is attracted to the receptors on the tumour cells. This treatment is used for advanced or metastatic NETs. Its use in lung NETs is limited to clinical trials and the FDA has not yet approved it. Embolization- Hepatic artery embolization: This is a procedure that blocks the blood supply to the tumour, which can shrink it or slow its growth. Conclusion It’s important to note that treatment plans for NETs of the lung are usually tailored to the specific needs of each patient and may involve a combination of these treatments. It is important to consult with a specialized team of doctors to determine the best treatment option for an individual patient.