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Robotic sympathetic trunk reconstruction for compensatory sweating after thoracic sympathectomy
Lisa Wen-Yu Chen1, Tommy Nai-Jen Chang1, Chin-Pang Lee2
1Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
JTCVS Techniques
|October 19, 2023
Summary
Robotic sympathetic trunk reconstruction (STR) effectively reverses disabling compensatory sweating (CS) after endoscopic thoracic sympathectomy. This 2-year study shows significant CS reduction and sustained improvements, offering a safe solution for patients.
Area of Science:
- Thoracic surgery
- Neurosurgery
- Regenerative medicine
Background:
- Endoscopic thoracic sympathectomy (ETS) can lead to disabling compensatory sweating (CS).
- Reversing CS after ETS presents a significant clinical challenge.
- Limited options exist for managing severe CS post-ETS.
Purpose of the Study:
- To evaluate the 2-year outcomes of robotic sympathetic trunk reconstruction (STR) for CS reversal.
- To assess the safety and efficacy of robotic STR in patients with post-ETS CS.
- To quantify improvements in CS severity and associated symptoms.
Main Methods:
- Prospective follow-up of 23 patients undergoing robotic STR for CS.
- Visual analog scale (0-10) used to assess CS severity, thermoregulatory alterations, and gustatory hyperhidrosis.
- Pre-STR baseline and 6-month, 2-year post-STR assessments.
Main Results:
- Mean age 43.3 years; 87% male. STR performed a mean of 19.6 years post-ETS.
- Successful nerve bridging with sural grafts (mean length ~9.7 cm) in all patients; no Horner syndrome.
- Significant CS reduction at all body areas maintained at 24 months; no recurrence or new CS sites.
- Improvements noted in thermoregulation and gustatory hyperhidrosis.
Conclusions:
- Robotic STR is a safe and effective procedure for reversing disabling compensatory sweating.
- The benefits of robotic STR for CS reversal are sustained at 2 years post-procedure.
- This technique offers a viable solution for patients suffering from severe CS after ETS.
