Thoughts were given about using the robotic device when performing thoracic or lumbar sympathectomy. In thoracic sympathectomy (ETS) it has no practical role. The setup of the robotic surgical device takes a long time before the surgery is even started. In this amount of time the NON-robotic approach (ETS) can be finished for both sides. The incisions needed for the robotic approach are bigger. In Dr. Reisfeld’s opinion the motivations to try this approach is mainly a financial one. Since the mid 1990’s we were able to achieve extremely high success rates coupled with excellent safety records with the non robotic approach. Robotic surgery is a newer technique that should only be done in certain types of cases where endoscopic surgery cannot achieve the same level of success and safety. That being said, Dr. Reisfeld’s opinion is that robotic surgery for hyperhidrosis (ETS, ELS) is unnecessary. Plantar hyperhidrosis (foot sweating treatment) can be treated in a very safe, efficient manner and with excellent results with endoscopic lumbar sympathectomy. Again, the time spent on setting up the robot is long and by that time the operation can be done with a simple endoscopic (non-robotic) approach. In the time of rising healthcare costs attention should be given to the cost factor. With robotic surgery the costs can be 2-3 times as much.
Recently the possibility of doing robotic surgery through a single incision was made available however that incision is larger than the 1-3 small incisions used in the ETS or ELS procedures. Having a bigger incision has the consequences of a higher amount of pain, a bigger scar, and the possibility of hernia formation when the procedure is done for lumbar sympathectomy. As new information becomes available we will provide here.
Pros of robotic surgery
For this particular surgery Dr. Reisfeld believes there are no advantages over endoscopic surgery.
Cons of robotic surgery
- Unnecessary Added cost of the surgery
- Requires larger incisions
- Entire procedure takes longer
- A more complex procedure sometimes involving more manpower