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Thoracic Surgery

Overview

Thoracic surgery is a medical specialty that focuses on the diagnosis and surgical treatment of conditions and diseases that affect the organs and structures within the chest or thoracic cavity. The surgical discipline primarily deals with procedures involving the Lungs, pleura (lining of lungs) oesophagus (food pipe), trachea (windpipe), diaphragm, chest wall, ribs and mediastinum (the space in the chest between the lungs).

Max Healthcare, one of the premier hospitals for thoracic surgery in Delhi, India, is at the forefront of medical innovation, offering cutting-edge diagnostic and treatment facilities along with participation in groundbreaking clinical trials. Our team of highly skilled thoracic surgeons work closely with other medical specialists, including lung surgeons, paediatric thoracic surgeons, cardiologists, pulmonologists, anesthesiologists, oncologists, and others to provide comprehensive care for patients with thoracic conditions.

We specialise in minimally invasive surgical approaches for thoracic diseases, utilising techniques such as thoracoscopy (VATS), uniportal VATS, awake VATS, laparoscopy, and robot-assisted procedures with the da Vinci XI system. These advanced methods offer patients the benefit of lower risk, reduced pain, minimal scarring, and faster recovery, ensuring the best possible outcomes for those in need of thoracic surgery.

Conditions We Treat

Lung Conditions/Diseases

Bronchiectasis

Bronchiectasis is a disease in which there is a permanent and irreversible enlargement of the airways of the lung. Causes can be both acquired and congenital (since birth). Common symptoms are cough with excessive sputum, blood in cough, foul-smelling breath, frequent chest infections and breathlessness. Surgical removal of the diseased lung part is advised in patients not responding to medical treatment. At Max, we do these surgeries with keyhole techniques also.

Aspergilloma

An aspergilloma, also known as a mycetoma or fungus ball, occurs in patients with pre-existing cavitary lung diseases such as tuberculosis. It may be asymptomatic or, cause coughing, blood in sputum or even life-threatening bleeding. Medical treatment is usually not effective. Surgical removal of diseased parts of the lungs in symptomatic patients (even asymptomatic) provides a permanent cure. At Max, we do these surgeries by all three techniques depending on indications and feasibility.

Hydatid Cyst in the Lung

Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. It can also occur in the lungs along with other parts of the body. Common symptoms are chest pain, cough, breathlessness and blood in cough. Treatment of choice is surgical removal of the diseased part or capitonnage of the cyst.

Lung Bullae and Blebs

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.  These are very fragile and are likely to burst. When they do burst, the entire lung collapses as a result of pneumothorax. Patients may experience difficulty in breathing, chronic coughing, chest pain, and other symptoms (lack of oxygen in the blood). Surgery is usually needed in patients with large bullae causing breathlessness, increasing size of bulla, recurrent pneumothorax, infected bullae not responding to medical treatment, acute respiratory failure, and acute distension of the bulla. We offer key-hole surgery to these patients with excellent outcomes.

Emphysema

Emphysema is a disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung). Lung volume reduction surgery (LVRS) is a surgical procedure to remove diseased, emphysematous lung tissue. This procedure reduces the size of an over-inflated lung and allows the expansion (growth) of the remaining, often more functional lung. LVRS improves exercise capacity, lung function and quality of life. We offer key-hole surgery to these patients with excellent outcomes

Lung Nodules

Lung nodules usually show up on a chest X-ray or a CT scan that has been carried out on a person who has symptoms of a respiratory illness. Nodules can occur in the lungs due to various causes ranging from infections to cancer. We at Max Hospital have a specialised team of doctors who evaluate and treat patients having lung nodules. Surgery if required is done by keyhole method after precise preoperative localization of the nodule.

Lung Cancer

Lung cancer (LC) is the leading cause of cancer-related deaths in India and globally. People who smoke have the greatest risk of lung cancer, though lung cancer can also occur in people who have never smoked. The most common symptoms are coughing (including coughing up blood), weight loss, shortness of breath, and chest pain. At Max we have a dedicated team for lung cancer treatment including a thoracic surgeon, pulmonologist, medical oncologist, radiation oncologist, pathologist, physical therapist, dietitian who together provide comprehensive personalised care to the patient. We also have state of art infrastructure and equipment required for disease evaluation and treatment. Our surgeons also offer lung-conserving surgery to remove the cancer completely and yet preserve remaining lung tissue whenever possible. We prefer minimally invasive techniques to do these surgeries.

Pleural Cavity-Related Conditions/Diseases

The pleural cavity is the space that lies between the pleura, the two thin membranes that line and surround the lungs.

Empyema Thoracic

Empyema is a collection of pus in between the lung and the inner surface of the chest wall (pleural space). Common causes for empyema are tuberculosis, pneumonia, penetrating chest injury, esophageal rupture, complications from lung surgery, or inoculation of the pleural cavity after needle aspiration or chest tube placement. Sometimes a peel forms over the lung surface and inner lining of the chest ch restricts the expansion of the lung along with poor penetration of antibiotics. VATS decortication removes all the pus from the chest cavity along with the complete peel allowing the lung to expand.

Drainage & Control of Hemothorax

Hemothorax is a condition wherein blood collects between the chest wall and the lungs. Most common cause of hemothorax is chest injury. Hemothorax is commonly treated by inserting a tube into the chest cavity. Sometimes the blood is clotted or loculated or may get infected to form an empyema. These patients often need surgical drainage. We do treat these patients by keyhole surgery. Broken ribs (usually seen in patients with trauma) may also be fixed during the surgery if indicated.

Diagnostic Thoracoscopy

Thoracoscopy is recommended to establish a diagnosis in patients with undiagnosed pleural effusions. It allows direct visual assessment of the pleura and subsequent biopsy of visually abnormal areas, hence maximising diagnostic yield. Thoracoscopy may be performed either under general anaesthesia or under sedation with local anaesthetic. Pleurodesis can be undertaken during thoracoscopy if the pleura appears abnormal on direct inspection to prevent the recurrence of pleural effusion.

Chylothorax

Results from leakage of lymphatic fluid from the thoracic duct. It usually happens after trauma, oesophageal or cardiac surgery and sometimes in malignancies like lymphoma. Surgery maybe required if conservative treatment fails. Thoracoscopic ligation of the thoracic duct provides a safe and effective treatment of chylothorax and may avoid thoracotomy and its associated morbidity.

Mediastinum Related Conditions/Diseases

Mediastinum is an area found in the midline of the chest that is surrounded by the breastbone in front, the spine in back, and the lungs on each side. It contains the heart, thymus gland, portions of the oesophagus and trachea, and other neuro-lymphoid structures.

Myasthenia Gravis

Myasthenia gravis is an autoimmune disorder, characterised by weakness and rapid fatigue of any of the muscles under voluntary control. Around 10-15 percent of people with myasthenia gravis have a thymoma. Another 60%, however, will have other abnormalities of the gland including thymic hyperplasia (an enlarged gland). Thymectomy has been a mainstay in the surgical treatment of myasthenia gravis and helps over 85% of myasthenia gravis patients. We do extended thymectomy by minimally invasive /robotic techniques.

Thymoma

Thymoma is a tumour of the thymus gland. Patients with thymoma may also have other autoimmune disease (like myasthenia, and pure red cell aplasia). Most of the patients don’t have any symptoms and the tumour is detected incidentally. Complete surgical removal helps long-term cures for these patients. We offer key-hole & robotic surgery to these patients with excellent outcomes.

Mediastinal Masses

Mediastinal masses are caused by a variety of cysts and tumours. Likely causes differ by patient age and by location of the mass (anterior, middle, or posterior mediastinum). Mediastinal tumours (both benign and malignant) that are left untreated can cause serious complications including invading the heart, pericardium (the lining around the heart), and great vessels (the aorta and vena cava).

Tumours located in the posterior (back) mediastinum can cause compression of the spinal cord. Almost 40% of people who have mediastinal tumours experience no symptoms. Most of the growths are often discovered incidentally on a chest x-ray which is performed for some other reason. When symptoms are present they are often a result of the compression of surrounding structures, such as the spinal cord, heart or the pericardium (the heart’s lining). Treatment depends on the cause. Most malignant tumours should be removed surgically, but some, such as lymphomas, are best treated with chemotherapy.

Oesophagus Related Conditions/Diseases

The oesophagus or food pipe is a muscular tube that moves food and liquid from the throat to the stomach.

Benign Esophageal Tumours

These are non-cancerous tumours on the wall of the oesophagus and not life-threatening. These often go undetected until they grow large enough to make swallowing difficult. We do surgical excision of these tumours by VATS / robotic surgery.

Esophageal Cancer

Esophageal Cancer is a disease in which malignant (cancer) cells form in the tissues of the oesophagus. At Max, we have a dedicated team of experts including a thoracic surgeon, gastroenterologist, medical oncologist, radiation oncologist, pathologist, physical therapist, and dietitian who together provide comprehensive personalised care to the patient. We also have state of art infrastructure and equipment required for disease evaluation and treatment. We use minimally invasive techniques including VATS and robotic techniques to perform these surgeries.

Esophageal Cysts

May cause symptoms like difficulty in swallowing and problems with breathing. We do surgical excision of these tumours by VATS/ robotic surgery

Esophageal Diverticula

Esophageal diverticula are small pouches that form in the oesophagus. Most patients are unaware of these pouches until they fill with food and become inflamed or infected, also known as diverticulitis. Symptoms are difficulty swallowing, heartburn, regurgitation of food, hoarseness, repeated pneumonia, repeated episodes of inhaling food into the airway or lungs, and bad breath. We offer key-hole surgery to these patients with excellent outcomes

Airway (Trachea & Bronchus) Related Conditions/Diseases

Tumours can block the airway and cause breathing problems. Most of the tumours that form in the trachea and bronchi in adults are cancerous, but a few are noncancerous. Multidisciplinary experts at Max Hospital are experienced in selecting the appropriate treatments for patients with tracheal and bronchial tumours. Treatment may include surgical excision, bronchoscopic treatments or radiation therapy, either alone or in combination. In patients who are not candidates for complete surgical removal of the tumour, these therapies may be used to help restore breathing and slow down the tumour progression.

Other airway diseases treated surgically are tracheal stenosis, tracheobronchomalacia and tracheoesophageal fistula

Pericardium Related Conditions/Diseases

The pericardium is a thin sac that surrounds the heart. It protects the heart and provides the lubrication for the heart.

Constrictive Pericarditis

Constrictive pericarditis is long-term inflammation of the pericardium. Inflammation in this part of the heart causes scarring, thickening, muscle tightening, or contracture. If it is left untreated, a rigid pericardium can lead to symptoms of heart failure, which may even be life-threatening. A most common cause is tuberculosis. There are effective treatments for the condition. The definitive treatment for constrictive pericarditis is pericardiectomy which is a surgical procedure where the entire pericardium is peeled away from the heart. This allows the heart to move freely.

Pericardial Window

A pericardial window is done to drain the excessive fluid around the heart. It can also help diagnose the source of the extra fluid. Conditions that might need a pericardial window include tuberculosis, metastatic cancer, immune system disease and metabolic causes, like kidney failure with uremia. We offer key-hole surgery to these patients with excellent outcomes

Diaphragm Related Conditions/Diseases

Diaphragm, a dome-shaped, muscular and membranous structure that separates the thoracic (chest) and abdominal cavities. It is the primary muscle used in respiration, as the diaphragm contracts, the volume of the thoracic cavity increases and air is drawn into the lungs.

Eventration & Paralysis of Diaphragm

The term ‘diaphragmatic eventration’ is used in common practice to describe a condition of relaxation of the diaphragmatic dome. It may present at birth as a congenital condition due to a defect of diaphragmatic development or in a later stage of life as an acquired condition (‘acquired diaphragmatic paralysis’ or ‘acquired diaphragmatic elevation’).

The patients may experience respiratory symptoms such as breathlessness, cough or chest pain, particularly on exertion. The goal of surgical correction is to place the diaphragmatic leaflet in a position of maximum inspiration which relieves compression on the lung parenchyma and allows its re-expansion

We offer key-hole surgery/robotic plication to these patients with excellent outcomes

Diaphragmatic Hernia

Holes in the diaphragm leading to abdominal structures coming into thoracic cavities. This can be due to some injury /trauma, post-surgery or even from birth. These have to be repaired irrespective of whether they are symptomatic or not. We offer minimally invasive/VATS/robotic techniques for the problem.

Chest Wall-Related Conditions/Diseases

The chest wall is also known as a thoracic wall, it is the boundary of the thoracic cavity and contains the skin, muscles and ribs.

Tumours

Chest wall tumours may be malignant (cancerous) or benign (non-cancerous), and may originate there or have spread from elsewhere.

Treatment can vary based on factors such as the type of tumour and the stage of its progression. Surgical resection is the mainstay of treatment for most early-stage chest wall tumours. Additional treatment can include radiotherapy and/or chemotherapy. At Max Hospital the thoracic surgeon will coordinate a team of specialists in the management of this disease, to offer chest wall resection and reconstruction.

Deformities

Chest wall deformities are structural abnormalities in the chest. These structural abnormalities can be classified into two different types:

  1. Pectus excavatum: known as “sunken” or “funnel” chest,

  2. Pectus carinatum: known as “pigeon” chest

At Max Hospital our surgeons use minimally invasive techniques (NUSS technique) to correct these deformities

Infections/Sinuses

Chest wall infection may occur in soft tissue, cartilage and bone. Treatment depends on the type location and magnitude of the infection. Treatment may range from the use of antibiotics to surgical resection of devitalized tissue and subsequent coverage with well-vascularized soft tissue. At Max hospital, the thoracic surgeon will coordinate a team of specialists in the management of this disease.

Rib Fractures

The treatment options for broken ribs depend on the severity and location of the fractures, as well as the presence of any associated injuries. In most cases, broken ribs can be managed with non-surgical treatments, such as pain medication, rest, and breathing exercises. However, in more severe cases, surgical intervention may be necessary. Surgery for rib fractures is typically reserved for cases where there is a high risk of complications or when non-surgical treatments have been ineffective.

Palmar-Plantar Hyperhidrosis

Hyperhidrosis is a condition characterised by abnormally increased sweating of hands and feet, in excess of that required for regulation of body temperature. Besides disrupting normal daily activities, this type of heavy sweating can cause social anxiety and embarrassment. It is a medical condition wherein the patients aren’t able to join the armed forces, which also makes their professional life (in a few selected fields) virtually impossible. While there are several non-surgical treatments available, hyperhidrosis surgery (thoracoscopic sympathectomy) is often the best solution for those who have tried everything else without success.

Minimally Invasive Surgery Options at Max Hospitals

Traditionally these surgeries were done by making big incisions over the chest, cutting all the muscles of the chest wall and applying a retractor to spread the ribs or cutting the breast bone to get into the chest and do these operations. This causes immense trauma to the patient leading to delayed recovery from surgery, excessive pain and high rates of postoperative complications. We do most of these procedures by minimally invasive techniques which are VATS and robotic thoracic surgery.

Video-Assisted Thoracoscopic Surgery (VATS)

VATS is minimally invasive thoracic surgery performed by introducing a small camera and instruments through tiny cuts over the chest wall. VATS provides excellent visualisation of the thorax, allowing the surgery to be performed even in sick and elderly patients who have marginal pulmonary reserve. Almost all operations in the chest can be done by this technique which avoids excessive pain and complications of open surgery. It also offers better cosmesis and the patient can return to work very soon after the surgery. We also specialize in doing single-cut VATS known as Uniportal VATS. Another specialised form of VATS, called Awake VATS is also performed by our surgeons for patients who are unfit or very high risk for general anaesthesia.

Robot-Assisted Thoracic Surgery (RATS)

Robotic Thoracic Surgery is an integral part of Max Hospital. Here, we offer the latest cutting-edge technology (da Vinci Xi robotic system) to provide the best outcome to our patients. The surgeon at the robotic console controls the robot to do the precise surgery of the patients along with all the benefits of minimally invasive surgery. Robotic technology provides highly magnified 3-D visualisation and excellent dexterity by 7 degrees of freedom of robotic instruments which allow difficult dissections in narrow fields with better surgical ergonomics. This allows the surgeon to perform technically demanding complex operations with great precision and ease.

Preparing for Thoracic Surgery

When preparing for thoracic surgery, individuals should communicate openly with their healthcare provider and follow these essential steps:

Medication Disclosure: It is crucial for the patient to inform their healthcare provider about all medications they are currently taking, including over-the-counter drugs. This information is vital for necessary adjustments to the medication regimen as required.

Medication Management: Any modifications to the medication should only be made under the direct guidance of the healthcare provider, particularly in the days leading up to the surgery. Altering medications without explicit instructions is discouraged.

Tobacco Cessation: To reduce the risk of complications, individuals should contemplate quitting the use of tobacco products at least one month before their scheduled lung surgery. Maintaining this cessation for a month post-procedure is highly advisable.

Fasting Compliance: Strict adherence to fasting instructions provided by the healthcare provider on the day before or the morning of the surgery is essential to ensure a safe surgical experience.

Meal Preparation: Given the typically extended recovery period associated with thoracic surgery, individuals may consider preparing and freezing meals in advance. This proactive step can simplify mealtime and contribute to a more comfortable recovery process.

Postoperative Care & Recovery

Postoperative care and recovery following thoracic surgery require individuals to follow specific instructions and engage in essential self-care practices. Here are key aspects to consider during this phase:

Wound Care: Patients should follow their healthcare provider's guidance for wound care to prevent infections. They should diligently monitor the surgical site for any signs of redness, swelling, or discharge.

Pain Management: Pain management options should be discussed with the medical team, and patients should take prescribed pain medications as directed. Any severe or worsening pain should be reported promptly.

Respiratory Exercises: Engaging in deep breathing and coughing exercises as recommended helps maintain lung function and prevents complications like pneumonia.

Physical Activity: Patients should gradually increase their activity level as advised by their healthcare provider, avoiding strenuous activities initially and prioritising rest.

Medication Compliance: Continuing to take any prescribed medications as instructed, including antibiotics or blood thinners if prescribed, is vital.

Diet and Hydration: Following dietary guidelines provided by the healthcare provider is essential. Adequate hydration and a balanced diet promote healing.

Follow-Up Appointments: Patients should attend all scheduled follow-up appointments with their medical team, as these visits are essential for monitoring progress and addressing any concerns.

Emotional Support: Thoracic surgery and recovery can be emotionally challenging. Patients may seek support from friends, family, or a therapist to help cope with any anxiety or stress.

Patience and Rest: Complete recovery may take time. Patients should exercise patience, prioritise rest, and engage in self-care during this period.

By adhering to these postoperative care and recovery guidelines, individuals can enhance their chances of successful recuperation and a return to a healthier, more active life.

Risks of Thoracic Surgery

Thoracic surgery, like any medical procedure, carries certain inherent risks and potential complications. It's essential for individuals considering thoracic surgery to be aware of these risks and discuss them thoroughly with their healthcare provider. Some of the primary risks and complications associated with thoracic surgery include:

Infection: Surgical sites can become infected, leading to complications. Careful post-operative wound care and adherence to antibiotic protocols are essential in minimising this risk.

Anaesthesia Risks: Anesthesia carries its own set of risks, including allergic reactions and adverse effects on other organ systems. Anesthesiologists carefully assess patients and manage these risks.

Pneumonia: Thoracic surgery can make individuals more susceptible to developing pneumonia due to changes in lung function. Post-surgery breathing exercises and early mobilisation can help reduce this risk.

Bleeding: Excessive bleeding during or after surgery is a potential risk. Surgeons take precautions to minimise bleeding, but blood transfusions may be necessary in severe cases.

Blood Clots: Blood clots can form in the legs (deep vein thrombosis) or travel to the lungs (pulmonary embolism) after surgery. Mobility and blood-thinning medications are often used to prevent this.

Pulmonary Complications: These can include atelectasis (lung collapse) or pleural effusion (accumulation of fluid around the lungs). Breathing exercises and early ambulation can help prevent these issues.

Cardiac Complications: Thoracic surgery can strain the heart, leading to arrhythmias or other cardiac issues. Individuals with pre-existing heart conditions should be closely monitored during and after surgery.

Nerve Damage: Surgery near the chest and spine can occasionally lead to nerve damage, resulting in weakness or sensory changes.

Scar Tissue: Formation of scar tissue (adhesions) can occur inside the chest, potentially leading to pain and complications.

Persistent Symptoms: In some cases, surgery may not fully resolve the symptoms or condition it was intended to treat. It's important for patients to have realistic expectations.

Rare Complications: Although less common, there are rare but serious complications such as air leaks, damage to adjacent organs, or severe bleeding that may require additional procedures or interventions.

Patients should have a thorough discussion with their healthcare team to understand their specific risk profile, as it can vary based on factors such as the type of surgery, overall health, and underlying medical conditions. Surgeons and medical teams are committed to minimising these risks through meticulous planning and care, but informed decision-making and adherence to post-operative instructions are essential for a successful outcome.

Frequently Asked Questions about Thoracic Surgery

What is Thoracic Surgery?

Thoracic surgery is the surgical treatment of non-cardiac, benign and malignant diseases of the chest. The thoracic surgery specialists at Max Hospital, offer consultation and surgical management of a wide range of disorders and diseases involving:

  •       Lungs
  •       Pleura (Chest cavity)
  •       Trachea and bronchus (windpipe)
  •       Oesophagus (food pipe)
  •       Chest wall
  •       Diaphragm
  •       Mediastinum
  •       Chest Trauma
  •       Hyperhidrosis (excessive sweating): of axilla or hand.

What precautions should be taken after thoracic surgery?

Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay. Also avoid swimming, tennis, golf, or other activities that could strain your arm and shoulder muscles, until your doctor says it is okay.

What can you eat after thoracic surgery?

Eating a balanced diet with lots of calories and protein will help you heal after surgery. Try to eat a good protein source (such as meat, fish, or eggs) at each meal. You should also try to eat fruits, vegetables, and whole grains.

What to expect after thoracic surgery?

What to expect at home. Your recovery can take between six and 12 weeks depending on the type of operation you have had. The surgical team will be able to advise the likely length of recovery for your particular operation. You may feel tired and experience some discomfort when you get home.

Why is thoracic surgery considered to be a high-risk surgery?

Thoracic surgical patients often have multiple comorbidities due to the close association between lung cancer, smoking, emphysema and cardiovascular disease. These often predispose them to numerous potentially significant complications.

Can I walk after thoracic surgery?

You may be told not to lift or carry anything heavier than 10 pounds, or 4.5 kilograms (about a gallon, or 4 litres of milk), for 2 weeks after video-assisted thoracoscopic surgery and 6 to 8 weeks after open lung surgery. You may walk 2 or 3 times a day. Start with short distances and slowly increase how far you walk.

What organs are involved in thoracic surgery?

Thoracic surgery refers to operations on organs in the chest, including the heart, lungs and oesophagus. Examples of thoracic surgery include coronary artery bypass surgery, heart transplant, lung transplant and removal of parts of the lung affected by cancer.

How do you sleep after thoracic surgery?

You can sleep in any position that is comfortable. Some patients need to sleep sitting in an upright position at first. It may be painful to sleep on your side, but it will not hurt your heart or incisions.

What is the most common complication after thoracic injury?

Although there is a wide range of complications following thoracic trauma, respiratory failure, pneumonia, and pleural sepsis are the most common potentially preventable problems.

What are the techniques used in thoracic surgery?

The majority of patients have video-assisted thoracoscopic, laparoscopic, or robotic surgeries. By using small incisions, our surgeons minimise blood loss and reduce postoperative pain leading to shorter hospital stays and a faster recovery to daily activities.

What exercises can you do after thoracic surgery?

Run, walk, or bike vigorously. Play sports like tennis, golf, softball, swimming, or bowling, or do any other sport that could cause injury to your chest area. Slowly work up to walking for at least 30 minutes, total, every day. Start by walking 3 times a day for about 5 minutes each time.

How long does thoracic surgery last?

A thoracotomy typically takes 3 to 4 hours, and the surgical team will give you medicine to make you sleep through it. When the operation gets underway, your surgeon will start with a cut around 6 inches long on your left or right side, just below the tip of your shoulder blade, if it's an open surgery or one, two or three tiny incisions in case of VATS or Robotic.

Review

Reviewed by Dr. Kamran Ali - Principal Consultant- Thoracic Surgery, Lung Transplant on 09-Jan-2024.

Thoracic Surgery: Condition & Treatments

Hyperhidrosis(Excessive Sweating)

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