title: Robotic intercostal nerve graft for reversal of thoracic sympathectomy: a large animal feasibility model.
abstract: BACKGROUND
  A subset of patients who undergo video-assisted thoracoscopic sympathectomy for hyperhydrosis develop post-procedure compensatory sweating that is perceived as more debilitating than their initial complaints. We propose a novel treatment to reverse sympathectomy by implantation of an intercostal nerve graft using the da Vinci robot.
  
  
  METHODS
  A robotic swine model was established using single-lung ventilation and four ports. The pleura was incised and a representative segment of sympathetic chain was transected. A nearby intercostal nerve was harvested and sutured to the sympathetic chain using four interrupted 10-0 nylon sutures on the epineurium.
  
  
  RESULTS
  The intercostal nerve was an excellent size match and post-procedure necropsy yielded successful anastomoses without apparent complications.
  
  
  CONCLUSIONS
  Robotic intercostal nerve grafting for reversal of thoracic sympathectomy is technically feasible. The robotic device allows the principles of neural microsurgery to be maintained and provides a minimally invasive option for reconstruction of the sympathetic chain.
authors.affiliation: Department of Surgery, St. Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York 10019, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Latif
authors.forename: J N
authors.initials: JN
authors.lastname: Afthinos
authors.forename: C P
authors.initials: CP
authors.lastname: Connery
authors.forename: N
authors.initials: N
authors.lastname: Perin
authors.forename: F Y
authors.initials: FY
authors.lastname: Bhora
authors.forename: M
authors.initials: M
authors.lastname: Chwajol
authors.forename: G J
authors.initials: GJ
authors.lastname: Todd
authors.forename: S J
authors.initials: SJ
authors.lastname: Belsley
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005240:Feasibility Studies; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D007367:Intercostal Nerves / Q000637:transplantation*; D012371:Robotics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013552:Swine; D013562:Sympathectomy / Q000295:instrumentation / Q000379:methods*; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome