Objective
Reversal surgery can be the solution for the adverse effects of Endoscopic thoracic sympathectomy (ETS). However, the divergent results and procedures had been reported without consensus. This study aimed to review literatures and summarize current reversal techniques, outcomes, and limitations.

Material and Methods
A review was conducted in the literatures from PubMed focusing on currently published studies for thoracic sympathetic trunk interruption reversal and reconstruction. Eligible studies included related animal model and clinical studies. Thorough comparing between surgical techniques, outcome evaluation methods, clinical results and complications were performed.

Results
Totally 25 experimental (n=3) and clinical (n=22) reports included. The surgical technique classified into unclipping, pedicled intercostal nerve, and free nerve grafting. The unclipping method limited in the clipped sympathectomy, and the result varied from 0-100% based on the different setup. Two studies introduced pedicled intercostal nerve flipped-over technique with 47.4-88% clinically improvement. Direct sympathetic trunk reconstruction was reported with vein grafting (n=1) and free nerve grafting (n=8); the nerve coapted via fibrin glue (n=3), suture (n=4), or combined (n=2); and the approaches revolute from open thoracotomy (n=2), VATS (n=3) to Da Vinci robotic technique (n=4) by time. The improvement varied between studies from 36.8 to 100%.

Conclusion
The details sympathetic trunk reconstruction is evolving and maturing by time. Robotic system definitely improves the dedication of the manipulation via identifying the healthy nerve stumps, tension free suture via the fascicular repair, and immobilization after coaptation. The outcomes improved by time but more standardized evaluation methods needs to be established in the future.