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Robotic Sympathetic Solutions for ETS Reversal in India: Side Effects and Risks

By Dr. Shaiwal Khandelwal in Thoracic Surgery

Dec 04 , 2024 | 1 min read

Hyperhidrosis (excessive sweating of hands, feet, and face) is very common and affects around 3% of the population. Individuals suffering from it experience profound embarrassment at the social, psychological, professional, and emotional levels with a significant degree of impairment of quality of life. Endoscopic Thoracoscopic Sympathectomy (ETS surgery) is often done in patients who have severe hyperhidrosis of hands and armpits, which is not adequately responding to various non-surgical methods (iontophoresis, aluminium chloride wipes, anticholinergic medications, botox, etc.). During ETS, the sympathetic nerve that runs close to the spine is cut, burnt, or clamped. The results of ETS are immediate and often permanent; around 95% of patients get dry hands after ETS.

The side effects of ETS can be mild to devastating, with more than 80% of people developing the undesired symptoms. The common side effects are compensatory sweating, gustatory sweating, thermoregulatory disorders, brain fogging, poor concentration, emotionlessness, decreased energy levels, decreased libido, excessively dry hands, etc. At times, these symptoms are devastating, with a poorer quality of life than before ETS. Such individuals regret surgery and seek reversal of ETS.

Restoring nerve continuity through reconstructing the previously interrupted sympathetic nerve appears to be an ideal solution to reverse symptoms in patients who develop intolerable post-ETS CS and long-term improvement in quality of life. We are doing a robotic reconstruction of the sympathetic nerve. The robotic platform offers 3D HD magnified vision to identify these tiny nerves along with the endo wrist, and 7 degrees of freedom aid in performing this complex surgery with precision. The sympathetic nerve's previously cut or burnt ends are identified during surgery, and margins are freshened by removing scarred tissue. The patient’s intercostal nerve is harvested and sutured to the cut ends of the sympathetic nerve using microsurgical techniques. Our patients start to notice improvement around 4-6 months after surgery, with around 50-60% improvement in quality of life in one year. This improvement continues with the progression of nerve regeneration for several years.

This complex surgery is performed at very few centres worldwide, and we are possibly the only centre in India performing it.