Robot-Assisted Ramicotomy: Evaluation in a Swine Model

Abstract

Background: To evaluate the feasibility of robot-assisted thoracoscopic T2-T5 ramicotomy. Methods: In 5 pigs, a robot-assisted thoracoscopic T2-T5 ramicotomy was performed, followed by T2-T5 sympathectomy 10 min later. Ramicotomy and sympathectomy times, and core (esophageal) and surface (left front foot) temperatures, were monitored and recorded. Results: The procedure was successfully completed in all 5 animals. In all cases, the sympathetic chain remained intact. No major hemorrhage occurred. The mean operating time for T2-T5 ramicotomy from incision until transsection of the last efferent ramus was 34 min (32-40). After completion of the ramicotomy, a total T2-T5 sympathectomy was performed, with a mean duration of 7 min (4-12). Mean core temperature before the operation was 37.6°C (36.7-38.0). Mean surface temperature before the operation was 34.2°C (33.3-35.5). Ten minutes after completion of the ramicotomy, temperatures stabilized. Mean postramicotomy core temperature was 37.4°C (36.3-38) and mean postramicotomy surface temperature was 35.4°C (33.9-37). Mean postsympathectomy temperatures were: core 37.3°C (36.1-38) and surface 35.8°C (33.8-37.1). Conclusion: Robot-assisted thoracoscopic T2-T5 ramicotomy is feasible and effective in a porcine model.

The Rate of Compensatory Sweating and Clinical Outcomes of Selective Thoracoscopic Sympathectomy (Ramicotomy) in Patients with Primary Palmar Hyperhidrosis

“…They demonstrated that robotic ramicotomy is a successful technique with paramount hyperhidrosis relief and low compensated sweating rates (12). Consistently, in a porcine model, robotic-assisted thoracoscopic ramicotomy T2-T5 was shown to be an effective procedure, and the sympathetic chain was remained intact (13). Interestingly, T3 ramicotomy resulted in a lower rate of compensatory sweating compared to T3 sympathetic clipping, and there was no significant difference in the rate of satisfaction for palmar hyperhidrosis treatment (14).…”