title: Robotic selective postganglionic thoracic sympathectomy for the treatment of hyperhidrosis.
abstract: BACKGROUND
  The surgical management of hyperhidrosis is controversial. Robotic surgical systems with their high-definition magnified 3-dimensional view and increased maneuverability in a confined space may facilitate the technique of selective sympathectomy (ramicotomy). We present a case series of patients undergoing selective postganglionic thoracic sympathectomy using robotic technology.
  
  
  METHODS
  This study is a case series analysis of patients who underwent selective postganglionic thoracic sympathectomy from July 2006 to November 2011. The operation was performed on a video-assisted thoracoscopic surgery (VATS) platform. The robot was used for pleural dissection and division of the postganglionic sympathetic fibers and the communicating rami. The success of sympathectomy was assessed by intraoperative temperature measurement of the ipsilateral upper extremity, patient interviews, and scoring of the symptomatic nature of hyperhidrosis based on the Hyperhidrosis Disease Severity Scale.
  
  
  RESULTS
  There were 110 sympathectomies performed in 55 patients (25 men, 30 women). Simultaneous bilateral sympathectomy was performed in all patients. Median age was 28 years (range, 16 to 65 years). There was no conversion to thoracotomy. Complications were minor and were seen in 5 of 55 patients (9%). There were no deaths. Median hospital stay was 1 day (range, 1 to 4 days). Of the 55 patients, 53 (96%) had sustained relief of their hyperhidrosis at a median follow-up of 24 months (range, 3 to 36 months), and compensatory sweating was seen in 4 patients (7.2%).
  
  
  CONCLUSIONS
  Robotic thoracoscopic selective sympathectomy is an effective, feasible, and safe procedure with excellent relief of hyperhidrosis and low rates of compensatory sweating and complications.
authors.affiliation: Department of Vascular Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Coveliers
authors.forename: Mark
authors.initials: M
authors.lastname: Meyer
authors.forename: Farid
authors.initials: F
authors.lastname: Gharagozloo
authors.forename: Willem
authors.initials: W
authors.lastname: Wisselink
authors.forename: Jan
authors.initials: J
authors.lastname: Rauwerda
authors.forename: Marc
authors.initials: M
authors.lastname: Margolis
authors.forename: Barbara
authors.initials: B
authors.lastname: Tempesta
authors.forename: Eric
authors.initials: E
authors.lastname: Strother
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012371:Robotics; D013562:Sympathectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult