Bilateral Robot-Assisted Thoracic Sympathectomy for Hyperhidrosis

Objectives: Robot-assisted prostatectomy is already a standard procedure in many centers around the world. During the last years, several departments started with robot-assisted surgery in the thorax (RATS), too. The commonly performed procedures are anatomic lobectomies and mediastinal thymectomies. Because of the 3D optic with magnification, free grades of the robot arms and tremor filter RATS has the potential to provide a tool for more precise and controlled sympathectomies in hyperhidrosis patients. We analyzed our experience with bilateral robot-assisted sympathectomy.

Methods: We analyzed all robot-assisted sympathectomy since the beginning of our RATS program in 2015. All operations were performed by two certified console surgeons in the same standardized three-port technique without an assisted port. The analysis focused on demographics, operations, safety, costs and clinical course.

Result: Since 2015, a total of 24 robot-assisted thoracic sympathectomies were performed in 13 patients (male 5 (30.8%), female 8 (69.2%) with a mean age of 30.9 ± 13.0 years. In 10 patients, a bilateral approach was planned and performed. Operating time was 106 ± 39 minutes. Costs for robot-specific one-time material were estimated to be 500 euro per case. There was no conversion to open surgery and no in-hospital mortality. No complications occurred during hospital stay. Follow-up evaluations demonstrated that hyperhidrosis was successfully treated in all cases.

Conclusion: Our results show that robot-assisted thoracic sympathectomies can be safely performed with good results for patients with hyperhidrosis. As no significant complications occurred, the bilateral approach was possible in all planed patients. Further investigation must assess if RATS leads to better long-term results and justifies the slightly higher costs of RATS.

Publication History

Article published online:
19 February 2021