Robotic Staged Bilateral Selective Postganglionic Sympathectomy for Upper Extremity Hyperhydrosis
Stephan Gruessner, MD, Mark Meyer, MD, Barbara Tempesta, Farid Gharagozloo, MD.
Florida Hospital Celebration Health/ University of Central Florida, Celebration, FL, USA.
Background: Compensatory hyperhidrosis (CH) has been reported to be as high as 80% in patients following thoracic sympathectomy for upper extremity hyperhidrosis. CH rate is 7.2% with simultaneous bilateral robotic selective dorsal sympathectomy. We reviewed the results in patients who underwent staged bilateral robotic selective dorsal sympathectomy (SBRSS). Methods: A case series analysis of patients who underwent SBRSS was performed. The robot was used for division of the postganglionic sympathetic fibers and communicating rami to intercostal nerves 2, 3, and 4. The sympathetic chain was left intact. The operation was performed on the dominant side followed by the same procedure on the contralateral side after 4 weeks. The success of the sympathectomy was determined by intraoperative temperature measurement, patient interviews, and the Hyperhidrosis Disease Severity Scale. Results: There were 47 patients (22 men, 25 women). Mean age was 32+/- 7 years. Minor complications were seen in 4% of patients. One patient had transient heart block. One patient has a transient partial Horner’s syndrome. 40% of patients had transient CH after the surgery on the first side, and 45% after sympathectomy on the contralateral side. There were no deaths. Median hospitalization was 3 days. At a mean follow-up of 28 +/- 6 months, all patients (100%) had sustained relief of hyperhidrosis, and no patient exhibited sustained compensatory hyperhidrosis. Conclusion: SBRSS is associated with lower rate of compensatory hyperhidrosis than when the procedure is performed bilaterally in a simultaneous fashion. This procedure is associated with the lowest reported rate of compensatory hyperhidrosis.
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