Introduction

Thoracic sympathectomy or endoscopic thoracic surgery (ETS) techniques are used to surgically divide the sympathetic chain within the chest allowing targeted manipulation of the sympathetic system.  Outcomes include reduced palmar and/or axillary sweating (hyperhidrosis), and reduced facial blushing.

Thoracic sympathectomy for hyperhidrosis or facial blushing is usually performed via a VATS (video-assisted thoracoscopy) or ETS (endoscopic thoracic surgery) approach. However, with increasing availability and advancements in robotic technology, this procedure can now be performed safely and accurately via a robotic approach.

Robotic highly selective thoracic sympathectomy allows division of the actual branches of the sympathetic chain  (pre- and post-ganglionic fibres) that contribute to palmar (and axillary) hyperhidrosis and facial blushing.  Unlike VATS or ETS a robotic approach allows routine preservation of the main sympathetic chain reducing the incidence of complications/side-effects (including Horner’s syndrome and compensatory hyperhidrosis).

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Indications:

Palmar and axillary hyperhidrosis

Upper extremity hyperhidrosis is characterised by abnormal, excessive sweating that can occur in the hands and armpits/axilla.  Excessive sweating is commonly controlled by the sympathetic nervous system.  A minimally invasive approach (ETS or VATS) can be used to divide the main sympathetic chain or its branches can be divided via a robotic thoracic sympathectomy. Division of the sympathectic chain or its branches eliminates the excessive sympathetic nervous activity thereby reducing palmar and axillary sweating. 

Facial blushing

Treatment for blushing will depend on the cause but in a small group of people division of the nerves that cause the facial blood vessels to dilate will reduce facial blushing by reducing blood flow to the skin.

Robotic highly selective sympathectomy is performed using the latest robotic technology (De Vinci Xi robot). It is performed under general anaesthetic via 3 small incisions (8mm each). The robotic platform allows superior outcomes compared to VATS or EST due to the manual dexterity, 3D vision and 10x magnification of the robotic technique. The tiny branches of the sympathetic chain that control sweating to the upper arm and facial blushing are clearly visualized and selectively divided whilst the main sympathetic trunk remains intact

Outcomes:

Robotic thoracic sympathectomy allows safe targeted minimally invasive thoracic sympathectomy to be performed achieving a good cosmetic result with a low complication rate (complications including pain, Horners or compensatory hyperhidrosis are reduced compared with VATS or EST). Robotic selective sympathectomy for hyperhidrosis or facial blushing is usually performed as a day case or with one overnight in-patient stay.

Thoracic sympathectomy gives an excellent clinical outcome with a reduction of 93% for hyperhidrosis and 80-90% for facial blushing.