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Robotic Staged Bilateral Selective Postganglionic Sympathectomy for Upper-Extremity Hyperhidrosis.

Farid Gharagozloo¹, Mark Meyer², Barbara Tempesta¹

¹Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health, University of Central Florida, Celebration, FL.

Surgical Technology International

|April 7, 2020

Summary

This summary is machine-generated.

Staged bilateral robotic selective dorsal sympathectomy (SBRSS) offers a lower rate of compensatory hyperhidrosis (CH) compared to simultaneous procedures. This technique demonstrates the lowest reported CH incidence for hyperhidrosis treatment.

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Area of Science:

Thoracic surgery
Neurosurgery
Medical technology

Background:

Compensatory hyperhidrosis (CH) is a common complication following thoracic sympathectomy for upper-extremity hyperhidrosis, with rates up to 80%.
Simultaneous bilateral robotic selective dorsal sympathectomy has reported CH rates of 7.2%.
Investigating alternative surgical approaches is crucial to minimize CH incidence.

Purpose of the Study:

To evaluate the efficacy and safety of staged bilateral robotic selective dorsal sympathectomy (SBRSS) in treating hyperhidrosis.
To determine the rate of compensatory hyperhidrosis (CH) associated with the SBRSS procedure.
To compare the CH rate of SBRSS with other sympathectomy techniques.

Main Methods:

A case series analysis of 47 patients who underwent SBRSS was conducted.
Robotic sympathectomy involved dividing postganglionic sympathetic fibers to intercostal nerves 2, 3, and 4 on the dominant side, followed by the contralateral side after 4 weeks.
Success was assessed via intraoperative temperature, patient interviews, and the Hyperhidrosis Disease Severity Scale.

Main Results:

47 patients (mean age 22 ± 3 years) underwent SBRSS with 98% sustained hyperhidrosis relief at a mean follow-up of 28 months.
Transient CH occurred in 40% after the first surgery and 45% after the second.
Only one patient (2%) experienced sustained CH, and one patient (2%) had recurrent hyperhidrosis on the operated side. Minor complications were 4%.

Conclusions:

Staged bilateral robotic selective dorsal sympathectomy (SBRSS) is associated with a significantly lower rate of compensatory hyperhidrosis (CH) than simultaneous bilateral procedures.
SBRSS represents a promising technique for hyperhidrosis treatment, achieving the lowest reported CH rates.
The procedure demonstrates high efficacy in sustained hyperhidrosis relief with minimal long-term CH.