Monday, 18 May 2009

Laser Sweat Ablation - LSA - Update

Following all of the publicity surrounding the introduction of a new technique, there comes a time to sit back and reflect on the results.

In medicine, this is usually done through presenting cases and case series at research and clinical meetings - followed by publishing papers on the results in the medical press.

Nowadays, as there is such easy access for patients to find information via the internet, it is important that the public are also informed in addition to the more traditional methods of presenting results, as outlined above. It is essential that patients, prospective patients and the public in general have sufficient information to be able to make a decision as to whether a certain treatment might be suitable and so whether it might be worth booking an appointment with a specialist to find out more about that treatment or procedure.

This morning we have performed our third Laser Sweat Ablation (LSA). The patient left the clinic fit and well after a cup of tea, some 30 minutes or so after completion of the surgery.

However, shortly afterwards, I met our second LSA patient who has had a difficult post-operative course - hence the reason for this posting.

Although the original papers on this procedure have published the results and made the claims as outlined previously in this blog and associated websites (and hence in a lot of the press), our first two patients have not had the very quick recovery that appears to have been reported elsewhere.

Some of this may be learning curve of a new procedure. Some may be due to expectations having been raised higher than surgery can provide - after all, if you are having surgery on a sensitive area of skin, it is not going to heal instantly and so there will be a variety of symptoms of different severity that may continue until healing is complete - at about 3 - 6 months.

So then, without going into the same level of detail that we will be doing when we present our series at medical meetings, what have we learnt so far - and what have we changed already?

Our early findings:

Firstly - Laser Sweat Ablation (LSA) is a true walk-in walk-out procedure that can be performed under local anaesthetic in an operating theatre. There is no need for sedation or anything more than local anaesthetic.

Secondly - recovery is very variable. Both of our first two patients had considerable pain once the local anesthetic wore off.

Thirdly - both of the first two patients had a break down of the skin in the middle of the arm-pit after a few days. The scar tissue then thickened and tightened in both - in one patient excessively so causing a "pulling" sensation down the arm. Both found it hard (if not impossible) to raise the arm for the first few weeks post-operatively due to this tight scar tissue and the discomfort it caused.

One patient is through the early healing and four weeks later went off onto a year away, able to move without discomfort and with only a little sweat from the skin next to where the operation had been performed. The second has pulled a muscle on one arm which is probably an unrelated event, but this clearly hasn't helped the mobility nor discomfort on this side.

So how have we modified our approach?

Naturally we would not continue this procedure if we thought that all patients would get this level of discomfort from the procedure. In addition, other workers in this field have found they get good results - so therefore there must be modifications to the technique that can improve results and decrease complications.

So far we have:

1] Laser power - we reduced the laser power after the first case.

2] Delivery of laser energy to skin - we have changed the instruments we use and also the method of delivery of the laser energy to the sweat glands in the skin

3] Skin cooler - we now use a laser skin cooler that cools the outside of the skin whilst the laser heats the inside of the skin where the the sweat glands are situated

4] Clinical measurements - we are noting several measurements as we perform the LSA procedure, to identify the optimal treatment

5] Long acting local anaesthetic - we have introduced a final local anaesthetic injection at the end of the procedure that should last for several hours and give a better first night's sleep.


As with all new medical procedures, there is a learning curve. Despite a full and thorough training, the first procedure for a particular surgeon and team rarely goes without hitch.

By listening to our patients feedback and discussing any complications or problems with:
- our whole team
- the manufacturers of the laser and equipment
- Dr Blugerman who developed the technique
- other workers in the field
we aim to make the learning curve as short as possible, and to optimise the Laser Sweat Ablation procedure to give our patients the best possible results with the minimum of complications or discomfort.

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