Objective
Endoscopic thoracic sympathectomy (ETS) may be complicated by the onset of disabling compensatory sweating (CS). The purpose of this case series is to describe the mid-term outcomes of robotic sympathetic trunk reconstruction (STR) for the reversal of CS in patients who had undergone ETS.
Material and Methods
We conducted a retrospective study in patients who received robotic STR because of intolerable CS after ETS from October 2017 to November 2019. The severity of CS at different anatomical locations was examined before and after STR (every 6 months) using a visual analogue scale ([VAS]; range: 0−10; with values ≥7 indicating severe CS).
Results
Thirteen patients (11 men and 2 women, median age: 41 years) were included in the study. The median interval from ETS to STR was 21 years. The three most common sites showing severe CS before STR were the chest (100%), the back (100%), and the abdomen (76.9%). Robotic STR was carried out successfully in all participants (median operating time: 8.5 h). The nerve defects were bridged using sural nerves (median length: 10 cm). The severity of CS at 6 post-operative months decreased significantly – especially in the back and chest wall. These findings were not transient and were noticeably maintained at 18 post-SRT months. Neither recurrent hyperhidrosis at the primary site nor the transition of CS to other locations was observed.
Conclusions
Our results demonstrate the mid-term safety and effectiveness of robotic STR for reversing CS in patients who had undergone ETS.

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