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Gharagozloo. Mini-invasive Surg 2020;4:14 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.55

Original Article Open Access

Robotic selective thoracic sympathectomy for
hyperhidrosis

Farid Gharagozloo

Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health Celebration, University of Central Florida,
Celebration, Florida, FA 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, Florida 34786, USA.
E-mail: Gharagozloof@aol.com
How to cite this article: Gharagozloo F. Robotic selective thoracic sympathectomy for hyperhidrosis. Mini-invasive Surg
2020;4:14. http://dx.doi.org/10.20517/2574-1225.2019.55
Received: 5 Dec 2019 First Decision: 26 Jan 2020 Revised: 4 Feb 2020 Accepted: 18 Feb 2020 Published: 6 Mar 2020

Science Editor: Noriyoshi Sawabata Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract

Aim: Thoracic sympathectomy is indicated in patients with upper extremity hyperhidrosis. The success of
dorsal thoracic sympathectomy is judged by the rates of relief of hyperhidrosis, recurrence, and compensatory
hyperhidrosis. We studied robotic selective sympathectomy (RSS) directed at the division of the preganglionic and
postganglionic rami without interruption of the sympathetic chain.

Methods: During RSS, the preganglionic and postganglionic sympathetic fibers and communicating rami to
intercostal nerves 2, 3, and 4 are divided. The sympathetic chain is left intact.

Results: Forty-seven patients underwent RSS. RSS was performed in a staged fashion with the more symptomatic
side first, followed by the contralateral side after at least four weeks. Mean operative time was 67 ± 13 min for
unilateral RSS. There was no conversion to thoracotomy. The mean increase in ipsilateral palmar temperature was
1.2 ± 0.3 °C. Median hospital stay was three days (range 1-4 days). Complications included transient heart block
after sympathectomy on the second side in 1/47 (2%) and transient partial Horner’s syndrome which resolved in
two weeks in 1/47 (2%). There was no permanent Horner’s syndrome. Relief of hyperhidrosis was seen in 98%
of patients. At a mean follow up of 28 ± 6 months, 46/47 (98%) patients were free of sustained compensatory
hyperhidrosis.

Conclusion: RSS is associated with excellent relief of hyperhidrosis and the lowest reported rate of compensatory
hyperhidrosis.

© 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,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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