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Robotic Staged Bilateral Sympathectomy For Hyperhydrosis
Amine Bouri, BSN, RNFA, Farid Gharagozloo, MD, Ramachandra Reddy, MD, Daniel Beckles, MD, Prashant Shah, MD, Ugo Ogwudu, MD, Giuseppe Tavilla, MD, Amber Malhotra, MD.
Baylor Scott and White Medical Center, Temple, TX, USA.

BACKGROUND:Compensatory hyperhydrosis (CS) is the main cause of patient dissatisfaction after thoracic sympathectomy for palmar and axillary hyperhydrosis. CS has been reported in 52% to 88% of patients. Highly selective dorsal thoracic sympathectomy (HSDTS) is associated with lower rates of CS. However, historically HSDTS has been performed by thoracotomy and therefore has not been widely used. Robotic technology with 3D visualization, greater dexterity, and more accurate dissection may enables HSDTS using minimally invasive techniques. METHODS: 47 patients (22 men, 25 women) with bilateral axillary and palmar hyperhydrosis underwent robotic HSDTS through three ports in the chest. All patients underwent staged bilateral sympathectomy. The dominant side was approached first. The non-dominant side underwent sympathectomy two weeks following the dominant side. Postganglionic fibers from ganglia 2, 3 and 4 were divided with electrocautery. The interganglionic fibers deep to the sympathetic chain were divided . The sympathetic ganglia and the preganglionic fibers were left intact. Relief of hyperhidrosis and CS were evaluated using the Hyperhidrosis Disease Severity Scale (HDSS) immediately after surgery and at 3 months. RESULTS: Mean age was 22 +/- 3 yrs. All patients had a preop HDSS of D. Mean OR time was 67+/- 13 minutes. Mean increase in ipsolateral palmar temp. was 1.2 +/- 0.3 degrees. Median hospital stay was 3 days (range 1-4dys). Complications included transient heart block in 1/47 (2%), transient Horner's syndrome in 1/47 (2%). Immediately postop and at 3 months 46/47 pts, had HDSS of A. Transient CS immediately after the procedure was seen in 21/47 pts (45%). At 3 months 1/47 (2%) had sustained CS.
CONCLUSION: Minimally invasive highly selective dorsal thoracic sympathectomy is facilitated with the use of robotics. Although greater experience is necessary, robotic HSDTS may be associated with lower rate of CS and greater patient satisfaction when compared to other minimally invasive techniques.

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