https://www.laparoscopyhospital.com/SERV01.HTM
Palmar hyperhidrosis, characterized by excessive sweating of the hands, is a distressing condition that significantly affects patients’ quality of life. Traditional treatment methods, including topical agents, oral medications, and botulinum toxin injections, often provide only temporary relief. For severe and refractory cases, robotic bilateral T3 sympathectomy has emerged as a highly effective and minimally invasive surgical solution.
Understanding Sympathectomy and Its Rationale
The sympathetic nervous system regulates sweating, and overactivity of the thoracic sympathetic chain at the T3 level is the primary cause of palmar hyperhidrosis. Sympathectomy, the surgical interruption of the sympathetic chain, effectively blocks the nerve signals responsible for excessive sweating.
Why the T3 Level?
• T3 sympathectomy is specifically targeted for palmar hyperhidrosis while minimizing the risk of compensatory hyperhidrosis.
• Compared to T2 sympathectomy, which is associated with a higher risk of facial and scalp sweating disturbances, T3 sympathectomy offers better symptom control with fewer complications.
• The robotic approach allows precision and minimal collateral damage, leading to optimal patient outcomes.
The Role of Robotic-Assisted Surgery
Robotic-assisted surgery enhances the traditional thoracoscopic approach by providing:
• Superior 3D visualization, allowing precise dissection of the sympathetic chain.
• Increased dexterity and control, reducing the risk of nerve injury.
• Minimal trauma to surrounding tissues, leading to faster recovery and less postoperative pain.
Surgical Technique: Robotic Bilateral T3 Sympathectomy
1. Patient Positioning & Anesthesia:
• The patient is placed in a semi-Fowler’s position with arms abducted.
• General anesthesia with single-lung ventilation is used to facilitate thoracic access.
2. Port Placement:
• Three 8 mm robotic ports are placed in the axillary region on each side.
• A CO₂ insufflation technique is used to create an optimal surgical field.
3. Identifying the Sympathetic Chain:
• The T3 sympathetic ganglion and its associated nerve fibers are carefully identified using robotic magnified visualization.
