2021-09-16

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Sympathetic Nerve Reconstruction (SNR)

About the sympathetic chain

Sympathetic nerves control many bodily functions, including respiratory movements, the heart, the lungs, the stomach, the small and large intestines, blood pressure, sleep, the gallbladder, the bladder, the pupils, the salivary glands, the oral cavity, and nasal mucosa. They play a crucial role in the human body.

About endoscopic thoracic sympathectomy (ETS)

Approximately 5% of the population in Asia suffer from excessive sweating (hyperhidrosis) in the palms due to sympathetic overactivity. In addition to causing many inconveniences in everyday life and negatively impacting their interpersonal relationships, affected people are also prone to developing skin diseases such as dyshidrosis and miliaria. Therefore, after the hospital introduced endoscopic thoracic sympathectomy (ETS), many people have inquired about the surgical procedure in hopes of solving this annoying disorder.

Sympathetic nerve block surgery (thoracotomy) had already been reported abroad in 1920. Surgeons in Taiwan began to perform thoracotomies in 1971, while the use of an endoscope in surgical procedures was introduced to Taiwan in 1990. The number of patients undergoing such procedures in Taiwan has soared since then. As of 2003, the number had reached nearly 300,000 people. The ETS operation involves burning or clamping the T2 (and/or) T3 (and/or) T4 in the sympathetic nerve.

The physical condition of most patients became worse after undergoing ETS surgery to treat palmar hyperhidrosis despite the symptoms having disappeared.

The primary side effects of this procedure include:

1. Compensatory sweating:
    Mainly occurs in the chest and abdomen, often making it necessary to frequently change clothes when the weather is hot.

2. Impaired thermoregulation:
    Patients are prone to dizziness, hot head and cold feet, frequent heat stroke, and even heat exhaustion.

3. Other sympathetic dysfunction issues:
    Including in the heartbeat, blood pressure, breathing, gastrointestinal, urinary, and reproductive systems.

4. Severe emotional distress:
    Inability to focus, irritability, and antisocial tendencies.

Sympathetic Nerve Reconstruction (SNR) Treatment

The Chang Gung Memorial Hospital "Robotic Sympathetic Trunk Microsurgical Reconstruction" was created with the efforts of the hospital's specialists. According to collected data, patients showed significant improvement in their symptoms after receiving reconstruction surgery.

The reconstruction surgery is a collaborative effort between different medical fields, with thoracic surgeons who specialize in robotic assisted da Vinci surgery and plastic surgery specialists in microsurgery. The surgeons from these two fields worked together to complete the procedure.

Detailed description of the division of labor for reconstruction surgery:

Thoracic surgery (Dr. Yin-Kai CHAO medical team)

1. Used the robotic arms of the da Vinci Surgical System to enter the thoracic cavity
2. Lifted the lungs, which had a mucosal layer
3. Separated the sympathetic chain and the intercostal nerves

Plastic surgery (Dr. Nai-Jen CHANG medical team)

1. Removed the sural nerve of the left foot
2. Performed anastomoses with the sural nerve
3. Microscopically sutured the sympathetic nerve chain to the intercostal nerves
* Since the sural nerve used is a sensory nerve, this procedure may lead to numbness in the heel and instep at first. However, the symptoms would disappear within six months and would not have any permanent effect on walking and motor functions.

Many patients showed significant improvements in their symptoms after undergoing the da Vinci Sympathetic Nerve Reconstruction.

For more information:
Video-Robotic Thoracic Sympathetic Trunk Microsurgical Reconstruction
Patient story-Argentinean hyperhidrosis patient regains normal life 
Thank you letter from sympathetic nerve chain reconstruction patient

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