Thoracic Surgery Department

Tel Aviv Sourasky Medical Center (Ichilov) operates a specialized surgical service for the treatment of excessive sweating (hyperhidrosis) within the Thoracic Surgery Department.

Hyperhidrosis is a common condition that can significantly affect patients' quality of life. It may cause physical discomfort, emotional distress, reduced self-confidence, and, in some cases, social difficulties.

Hyperhidrosis is divided into three main categories:

• Primary hyperhidrosis: Usually diagnosed by excluding other causes, this condition typically begins in childhood and worsens during adolescence. It primarily affects the palms and soles and may also involve the armpits and face.

• Generalized secondary hyperhidrosis: Associated with underlying medical conditions such as hyperthyroidism, obesity, hypoglycemia, pheochromocytoma, and less common conditions such as Buerger's disease.

• Focal secondary hyperhidrosis: Associated with damage to various parts of the nervous system, including the brain, spinal cord, or peripheral nerves.

The Hyperhidrosis Clinic primarily treats patients with primary hyperhidrosis. In selected cases of generalized or focal secondary hyperhidrosis, the decision to proceed with surgical treatment is made jointly by the referring physician and a thoracic surgeon, usually following a multidisciplinary consultation.

Surgical Treatment of Primary Hyperhidrosis

Several nonsurgical treatments are available for primary hyperhidrosis, including various topical therapies. However, conservative treatment is not sufficiently effective for some patients. In these cases, surgical intervention may offer an appropriate alternative.

The Pediatric Thoracic Surgery Unit at Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, provides advanced, personalized, multidisciplinary surgical care for children requiring diagnosis, monitoring, and thoracic surgery.

The Unit offers comprehensive surgical treatment for a wide range of thoracic conditions affecting premature infants, newborns, infants, and children.

The Unit has extensive clinical and surgical experience in treating congenital abnormalities in newborns and premature infants, as well as complex and rare thoracic conditions in children. Its multidisciplinary approach combines expertise in thoracic surgery, pediatric oncology, pulmonology, and advanced medical imaging.

This integrated approach supports accurate clinical decision-making and individualized treatment planning, taking into account medical, functional, and aesthetic considerations.

The Unit treats a wide range of thoracic tumors, including primary and secondary lung tumors, pulmonary metastases from other malignancies, mediastinal tumors, and chest wall tumors involving bone and soft tissue.

It also specializes in the diagnosis and surgical treatment of congenital deformities and abnormalities, including pectus excavatum (sunken chest), pectus carinatum (pigeon chest), congenital lung malformations, bronchogenic cysts, and other airway abnormalities.

In addition, the Unit treats urgent and acquired thoracic conditions, including recurrent pneumothorax, complex infections such as empyema and lung abscesses, and pleural effusions requiring drainage or surgical intervention.

Other areas of treatment include surgical management of hyperhidrosis through sympathectomy, diagnostic lung and mediastinal biopsies, treatment of benign lesions and cysts within the chest, and surgical correction of complications following lung diseases or previous treatments.

The Lung and Thoracic Surgery Clinic provides initial evaluation and assessment of patients with thoracic lesions and conditions at various stages of diagnosis.

Patients are encouraged to undergo an initial assessment by a pulmonologist before their first appointment at the Thoracic Surgery Clinic. However, this evaluation can also be performed directly at the clinic.

If the condition can be managed using nonsurgical methods, patients are referred to the Pulmonology Department, Oncology Department, or other relevant medical services, as appropriate.

Patients who have already been diagnosed or treated at Tel Aviv Sourasky Medical Center and have been referred for surgical treatment are invited to the clinic for a preliminary consultation.

During this appointment, a thoracic surgeon evaluates the patient's condition, explains the proposed procedure, and assesses the patient's suitability for surgery.

Patients who are considered suitable candidates are subsequently referred to the Preoperative Assessment Clinic.

The Indwelling Pleural Catheter Clinic provides outpatient management of chronic pleural effusions using indwelling pleural catheters, including PleurX catheters and chest drainage systems.

The Lung Volume Reduction Clinic provides specialized surgical treatment for patients with severe pulmonary emphysema, including lung volume reduction procedures performed under regional anesthesia without general anesthesia.

Pulmonary emphysema is a serious lung disease, most commonly caused by smoking-related damage to lung tissue.

The disease is characterized by the destruction of lung tissue and the formation of air-filled spaces known as bullae. These thin-walled air spaces impair lung function by reducing the lungs' ability to oxygenate the blood and effectively move air in and out.

In some patients, the bullae are distributed throughout the lungs, causing pulmonary hyperinflation. As a result, the lungs become excessively enlarged relative to the chest cavity, limiting their ability to expand and function properly during breathing.

Patients may experience significant shortness of breath during physical activity and, in more advanced cases, even at rest. These symptoms can severely affect quality of life and overall health.

Conservative Treatment

Conservative treatment aims to relieve symptoms, improve respiratory function, and slow disease progression.

Treatment includes smoking cessation, bronchodilator medications, supplemental oxygen when needed, and pulmonary rehabilitation through supervised exercises and individually adapted physical activity.

Surgical Treatment

In selected patients, lung volume reduction surgery (LVRS) may be performed to remove severely damaged, poorly functioning lung tissue.

By reducing lung volume, the procedure allows healthier portions of the lungs and the respiratory muscles to function more efficiently. This may help relieve shortness of breath and improve quality of life.

At Ichilov, the procedure is performed using a minimally invasive, video-assisted surgical approach, without the need for traditional open-chest surgery.

Anatomical lung segmentectomy is a surgical procedure involving the removal of a defined anatomical segment of the lung. The main challenge is to preserve as much healthy, functioning lung tissue as possible while achieving the required clinical outcome.

The Thoracic Surgery Department at Ichilov operates an innovative anatomical lung segmentectomy program, enabling precise, targeted removal of early-stage lung tumors while maximizing the preservation of healthy lung tissue and minimizing the impact on pulmonary function.

The program uses the advanced Synapse 3D system, which enables detailed preoperative planning through three-dimensional imaging and reconstruction of the lung's anatomical structures.