Robotic selective thoracic sympathectomy for hyperhidrosis

Abstract

Aim: Thoracic sympathectomy is indicated in patients with upper extremity hyperhidrosis. The success of dorsal thoracic sympathectomy is judged by the rates of relief of hyperhidrosis, recurrence, and compensatory hyperhidrosis. We studied robotic selective sympathectomy (RSS) directed at the division of the preganglionic and postganglionic rami without interruption of the sympathetic chain.

Methods: During RSS, the preganglionic and postganglionic sympathetic fibers and communicating rami to intercostal nerves 2, 3, and 4 are divided. The sympathetic chain is left intact.

Results: Forty-seven patients underwent RSS. RSS was performed in a staged fashion with the more symptomatic side first, followed by the contralateral side after at least four weeks. Mean operative time was 67 ± 13 min for unilateral RSS. There was no conversion to thoracotomy. The mean increase in ipsilateral palmar temperature was 1.2 ± 0.3 °C. Median hospital stay was three days (range 1-4 days). Complications included transient heart block after sympathectomy on the second side in 1/47 (2%) and transient partial Horner’s syndrome which resolved in two weeks in 1/47 (2%). There was no permanent Horner’s syndrome. Relief of hyperhidrosis was seen in 98% of patients. At a mean follow up of 28 ± 6 months, 46/47 (98%) patients were free of sustained compensatory hyperhidrosis.

Conclusion: RSS is associated with excellent relief of hyperhidrosis and the lowest reported rate of compensatory hyperhidrosis.

Keywords

Robotic / sympathectomy / hyperhidrosis / minimally invasive / selective sympathectomy

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