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Gharagozloo et al. Mini-invasive Surg 2020;4:48 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.35

Review Open Access

Minimally invasive surgical approaches to thoracic
sympathectomy for hyperhidrosis

Farid Gharagozloo, Mark Meyer

Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health Celebration, University of Central Florida,
Celebration, FL 34786, USA.
Correspondence to: Dr. Farid Gharagozloo, Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health
Celebration, University of Central Florida, 400 Celebration Place, Celebration, FL 34786, USA.
E-mail: farid.gharagozloo.md@adventhealth.com
How to cite this article: Gharagozloo F, Meyer M. Minimally invasive surgical approaches to thoracic sympathectomy for
hyperhidrosis. Mini-invasive Surg 2020;4:48. http://dx.doi.org/10.20517/2574-1225.2020.35
Received: 13 Apr 2020 First Decision: 13 May 2020 Revised: 18 May 2020 Accepted: 1 Jun 2020 Published: 7 Aug 2020

Academic Editor: Noriyoshi Sawabata Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Thoracic sympathectomy is used for the palliation of hyperhidrosis. However, significant controversies
surround the optimal surgical approach and the extent of sympathectomy. The determinants of success in
the surgical palliation of hyperhidrosis are the postoperative rate of anhidrosis, recurrence of symptoms, and
rate of compensatory hyperhidrosis. This paper attempts to shed light on the controversies by examining the
historic background, clearly defining the anatomic considerations, and outlining the various surgical approaches
culminating with robotic selective dorsal thoracic sympathectomy.

Keywords: Sympathectomy, hyperhidrosis, robotic, minimally invasive, thoracoscopic, selective sympathectomy

INTRODUCTION
Surgery on the sympathetic nervous system (SNS) is characterized by the evolution of indications and
techniques that have correlated with the evolution and understanding of the physiology and anatomy of
this complex part of the nervous system.

[1]
By the end of the 18th century, the anatomy of the sympathetic system was well described . However, it
was over a century later that a clearer understanding of the SNS as part of the autonomic nervous system
[2]
[3]
was achieved . In 1852, Bernard discovered that division of the cervical sympathetic trunk resulted in an
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
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