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BACKGROUND: Compensatory hyperhidrosis (CS) is the main cause of patient dissatisfaction after thoracic sympathectomy for palmar and axillary hyperhidrosis. CS has been reported in 52-88% of patients. Highly selective dorsal thoracic sympathectomy (HSDTS) is associated with lower rates of CS. HSDTS has been reported through a thoracotomy. Robotic technology with 3D magnified visualization, greater dexterity, and more accurate dissection enables HSDTS using minimally invasive techniques.
METHODS: 61 patients from December 2005 until December 2011 underwent bilateral HSDTS through 3 nontrocar ports in the chest. Pre and Postganglionic fibers from ganglia 2, 3, and 4 were divided with electrocautery. The interganglionic fibers were left intact. The sympathetic chain was left intact. Relief of hyperhidrosis and CS were evaluated using a subjective questionnaire.
RESULTS: Mean operative time was 113 +/- 26 minutes. Mean hospital stay was 2 days. Minor complications were seen in 8/61 (13%) patients which included gustatory sweating in 1 patient, transient Horner’s syndrome in 2 patients, dysesthesia in the right hand 5th digit in 1 patient, ptosis in 1 patient, severe intercostal neuralgia requiring gabapentin in 1 patient, and bradycardia in 2 patients. Compensatory hyperhidrosis was seen in 5/61 patients (8.2%). In 1 of these patients, the compensatory hyperhidrosis was transient and resolved after 1 month. There was no mortality. 56/61 (92%) patients were satisfied with the results of the sympathectomy.
CONCLUSION: Robotic highly selective dorsal thoracic sympathectomy is safe and effective for the relief of upper extremity hyperhidrosis. Robotic HSDTS is associated with a lower rate of CS and greater patient satisfaction when compared to other minimally invasive techniques.