Reversal of thoracic sympathectomy through robot‐assisted microsurgical sympathetic trunk reconstruction with sural nerve graft and additional end‐to‐side coaptation of the intercostal nerves: A case report

Abstract

Thoracic sympathectomy to treat palmar hyperhidrosis (PH) has widely been performed.Many patients regret the surgery due to compensatory hyperhidrosis (CH), gustatory hyperhidrosis, arrhythmia, hypertension, gastrointestinal disturbances, and emotional distress. Robotic applications in microsurgery are very limited. We report the technique and long-term patient-reported outcomes of bilateral robot-assisted microsurgical sympathetic trunk reconstruction with a sural nerve graft in an interdisciplinary setting. A 59-year-old female suffered from severe adverse effects after endoscopic thoracic sympathectomy (ETS) for PH 25 years ago. She reported CH over the whole trunk, gustatory hyperhidrosis, excessive dry hands, and emotional distress. An interdisciplinary surgical team performed a bilateral sympathetic trunk reversal reconstruction with an interpositional sural nerve graft per side by a da Vinci ® Robot. The nerve graft was microsurgically coapted using 9-0 sutures end-to-end to the sympathetic trunk stumps and side-to-end to the intercostal nerves T2-T4. At 24, 33 and 42 months, palmar dryness and emotional distress were strongly reduced. A highly specialized interdisciplinary setting may provide a precise, safe, and efficient treatment for ETS sequelae. A clinical study is initiated to validate this new therapy.

Does plastic surgery need a rewiring? A survey and systematic review on robotic-assisted surgery

“…Sixteen studies had less than 10 total patients and were excluded from formal analysis (Supplemental Table 1). 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24

Figure 5 PRISMA diagram.

…”

Robotic Sympathectomy for Hyperhidrosis

“…One patient developed palmar hyperidrosis which included the face while another developed pneumothorax [ 16 ]. In a case report by the same author, a 59-year-old woman who underwent an endoscopic thoracic sympathectomy (ETS) experienced serious side effects [ 17 ]. She displayed emotional anxiety, gustatory hyperhidrosis, overly dry hands, and compensatory hyperhidrosis across the entire trunk [ 17 ].…”

“…In a case report by the same author, a 59-year-old woman who underwent an endoscopic thoracic sympathectomy (ETS) experienced serious side effects [ 17 ]. She displayed emotional anxiety, gustatory hyperhidrosis, overly dry hands, and compensatory hyperhidrosis across the entire trunk [ 17 ]. Bilateral sympathetic trunk reversal repair using a Da Vinci Robot and an interpositional sural nerve graft on either side was performed by an interdisciplinary surgical team [ 17 ].…”

“…She displayed emotional anxiety, gustatory hyperhidrosis, overly dry hands, and compensatory hyperhidrosis across the entire trunk [ 17 ]. Bilateral sympathetic trunk reversal repair using a Da Vinci Robot and an interpositional sural nerve graft on either side was performed by an interdisciplinary surgical team [ 17 ]. The sympathetic trunk stumps and the T2-T4 intercostal nerves were closed with 9-0 sutures to create a microsurgical nerve graft [ 17 ].…”

“…Bilateral sympathetic trunk reversal repair using a Da Vinci Robot and an interpositional sural nerve graft on either side was performed by an interdisciplinary surgical team [ 17 ]. The sympathetic trunk stumps and the T2-T4 intercostal nerves were closed with 9-0 sutures to create a microsurgical nerve graft [ 17 ]. Palmar dryness and emotional anxiety were significantly reduced at 24, 33, and 42 months [ 17 ].…”