{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:23:47Z","timestamp":1769905427235,"version":"3.49.0"},"reference-count":13,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T00:00:00Z","timestamp":1626912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Thoracic sympathectomy to treat palmar hyperhidrosis (PH) has widely been performed. Many patients regret the surgery due to compensatory hyperhidrosis (CH), gustatory hyperhidrosis, arrhythmia, hypertension, gastrointestinal disturbances, and emotional distress. Robotic applications in microsurgery are very limited. We report the technique and long\u2010term patient\u2010reported outcomes of bilateral robot\u2010assisted microsurgical sympathetic trunk reconstruction with a sural nerve graft in an interdisciplinary setting. A 59\u2010year\u2010old female suffered from severe adverse effects after endoscopic thoracic sympathectomy (ETS) for PH 25\u2009years ago. She reported CH over the whole trunk, gustatory hyperhidrosis, excessive dry hands, and emotional distress. An interdisciplinary surgical team performed a bilateral sympathetic trunk reversal reconstruction with an interpositional sural nerve graft per side by a da Vinci\u00ae Robot. The nerve graft was microsurgically coapted using 9\u20130 sutures end\u2010to\u2010end to the sympathetic trunk stumps and side\u2010to\u2010end to the intercostal nerves T2\u2013T4. At 24, 33 and 42\u2009months, palmar dryness and emotional distress were strongly reduced. A highly specialized interdisciplinary setting may provide a precise, safe, and efficient treatment for ETS sequelae. A clinical study is initiated to validate this new therapy.<\/jats:p>","DOI":"10.1002\/micr.30787","type":"journal-article","created":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T12:55:50Z","timestamp":1626958550000},"page":"772-776","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Reversal of thoracic sympathectomy through robot\u2010assisted microsurgical sympathetic trunk reconstruction with sural nerve graft and additional end\u2010to\u2010side coaptation of the intercostal nerves: A case report"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6878-1574","authenticated-orcid":false,"given":"Tommy Nai\u2010Jen","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Chang Gung Medical College and Chang Gung University  Taoyuan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2252-1849","authenticated-orcid":false,"given":"Bassem W.","family":"Daniel","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Chang Gung Medical College and Chang Gung University  Taoyuan Taiwan"},{"name":"Department of Plastic and Hand Surgery University of Freiburg Medical Center  Freiburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5266-4947","authenticated-orcid":false,"given":"Angela Ting\u2010Wei","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Chang Gung Medical College and Chang Gung University  Taoyuan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6803-7174","authenticated-orcid":false,"given":"Lisa Wen\u2010Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Chang Gung Medical College and Chang Gung University  Taoyuan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9609-9583","authenticated-orcid":false,"given":"Cheyenne Wei\u2010Hsuan","family":"Sung","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Chang Gung Medical College and Chang Gung University  Taoyuan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6117-5600","authenticated-orcid":false,"given":"David Chwei\u2010Chin","family":"Chuang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Chang Gung Medical College and Chang Gung University  Taoyuan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8649-8783","authenticated-orcid":false,"given":"Yin\u2010Kai","family":"Chao","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Chang Gung Memorial Hospital\u2010Linkou Chang Gung University  Taoyuan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,7,22]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2019.08.52"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1722183"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.3171\/spi.2005.2.2.0151"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thorsurg.2016.06.007"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2010.25.4.597"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2004.02.087"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/11024159850191067"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2008.10.048"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2006.09.011"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1582431"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.7682"},{"issue":"580","key":"e_1_2_5_13_1","first-page":"17","article-title":"Secondary sympathetic chain reconstruction after endoscopic thoracic sympathicotomy","volume":"164","author":"Telaranta T.","year":"1998","journal-title":"The European Journal of Surgery. 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