Robotic Selective Dorsal Sympathectomy for Hyperhidrosis

Presently, hyperhidrosis is the most important established indication for thoracic sympathectomy. Historically, surgical sympathectomy for hyperhidrosis has been associated with three areas of controversy: the surgical approach; the technique of sympathectomy; and the extent of sympathectomy. Many surgical approaches have been described: the posterior thoracic approach; cervical supraclavicular approach; transthoracic approach; transaxillary approach; thoracoscopic approach; and robotic thoracoscopic approach. The most common approach to sympathectomy has been ganglionectomy. However, ganglionectomy has been associated with high rates of compensatory hyperhidrosis (1–3). Selective dorsal sympathectomy represents a more directed approach to sympathetic denervation of the upper extremity (2).

In this procedure, the sympathetic trunk and ganglia are left intact and only the preganglionic and postganglionic nerves as well as the communicating rami for intercostal nerves two, three, and four are divided. One study reported a success rate of up to percent and a compensatory hyperhidrosis rate of 2.5 percent after performing selective sympathectomy (4,5). Recently, another study reported a series of patients who underwent robotic simultaneous bilateral selective dorsal sympathectomy using a surgical robot (6,7). In addition, another study has shown a 98 percent relief of hyperhidrosis and only a 2 percent rate of compensatory hyperhidrosis following robotic staged bilateral selective dorsal sympathectomy (8). This video illustrates the technique of robotic selective dorsal thoracic sympathectomy.

References

1. Cerfolio RJ, De Campos JR, Bryant AS, Connery CP, Miller DL, et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg 2011;91:1642-8.
2. Baumgartner FJ, Toh Y. Severe hyperhydrosis: clinical features and current thoracoscopic surgical management. Ann Thorac Surg 2003;76:1878-83.
3. Schmidt J, Bechara FG, Altmeyer P, Zirngibl H. Endoscopic thoracic sympathectomy for severe hyperhydrosis: impact of restrictive denervation on compensatory hyperhydrosis. Ann Thorac Surg 2006;81:1048-55./span>
4. Friedel G, Linder A, Toomes H. Sympathectomy and agronomy. In: Mannke K, Rosin RD, editors. Minimal access thoracic surgery. London: Chapman Hall; 1998. pp. 67-83.
5. Friedel G, Linder A, Toomes H. Selective video-assisted thoracoscopic sympathectomy. Thorac Cardiovasc Surg 1993;41:245-8.
6. Coveliers H, Meyer M, Gharagozloo F, Wisselink W, Rauwerda J, et al. Robotic Selective Postganglionic Thoracic Sympathectomy for the treatment of hyperhidrosis. Ann Thorac Surg 2013;95:269-74.
7. Coveliers H, Meyer M, Gharagozloo F, Wisselink W. Selective Sympathectomy for hyperhidrosis: technique of robotic transthoracic selective postganglionic sympathectomy. Eur J Cardiovasc Surg 2013;43:428-30.
8. Gharagozloo F. Robotic Selective Thoracic sympathectomy for hyperhidrosis. Mini-invasive Surg 2020, 4:14-29

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