Seoul St. Mary's Hospital announced Wednesday that a team led by Professor Bang Seok-hwan of the Department of Urology successfully treated foot hyperhidrosis using single-port robotic surgery for the first time in Korea.
Hyperhidrosis is a condition in which excessive sweat is secreted from the hands, armpits, feet and other areas. The case in which excessive sweating persists on the soles of the feet is called foot hyperhidrosis. It is known to be caused by overactivity of the lumbar sympathetic ganglia at the second to fourth lumbar vertebrae (L2-L4). Because a safe and effective surgical method has not been widely established, patients have faced considerable difficulties. Even slight activity wets the shoes and worsens odor, causing significant disruption to interpersonal relationships, while also making skin conditions more likely to develop.
Until now, conservative therapies have mainly been used to treat foot hyperhidrosis, such as iontophoresis, which uses weak electrical currents to penetrate ionized substances into tissue, or Botox treatment, which works on the principle of blocking acetylcholine, the neurotransmitter at the nerve-sweat gland junction. However, the duration of the effect lasted only a few weeks to a few months.
Despite the advantage that surgical treatment can fundamentally address the underlying cause, the transperitoneal approach carried a heavy burden of complication risks such as intestinal adhesions and peritoneal irritation, as well as requiring considerable recovery time. The laparoscopic method, which makes three to four holes around the navel and inserts surgical instruments instead of cutting open the abdomen, also left problems of scarring and pain.
Professor Bang's team attempted a retroperitoneal-approach lumbar sympathectomy using the da Vinci SP (Single Port) single-port robot on a woman in her 20s who had been suffering from severe foot hyperhidrosis. Instead of going through the peritoneum, the method involves making a single incision of about 2 cm on the side of the abdomen, then inserting a robotic arm directly into the retroperitoneal space (toward the flank) to remove the L3 lumbar sympathetic ganglion located adjacent to the inferior vena cava. In addition, the incision was made along the underwear line at the inner area in front of the pelvic bone so that the surgical scar would not be easily visible. The team demonstrated that using a single-port dedicated robotic platform, which can simultaneously insert and operate a high-resolution 3D camera and multi-jointed surgical instruments through just one 8.5 mm-diameter cannula (medical tube), enables stable visibility and delicate dissection even in the narrow retroperitoneal space. It is expected not only to minimize the risks of conventional transperitoneal surgery but also to allow the patient to return to daily life much faster.
The patient, who visited the outpatient clinic for the first time 10 days after undergoing surgery on the 18th, shared the following impression: "I usually had a lot of sweat on my feet, so I couldn't go to places where I had to take off my shoes, but after the surgery there is no sweating and almost no scarring or pain, so I was able to return to daily life right away." Above all, since she had hesitated for a long time worried that scars would remain after surgery, her satisfaction with the surgical site not being noticeable was great.
The Department of Urology at Seoul St. Mary's Hospital has experience with more than 7,000 robotic surgeries across the entire range of urological cancers, including prostate cancer, kidney cancer and bladder cancer. The hospital assesses that the long-accumulated minimally invasive surgery experience in various fields led to this achievement.
"The accumulated retroperitoneal surgery experience and anatomical proficiency in the field of urology using the single-port robot served as a foundation for surgery on foot hyperhidrosis, an entirely different condition," Professor Bang said. "We will continue clinical research so that single-port robotic surgery can establish itself as a new minimally invasive treatment option for patients who experience difficulties in daily life due to foot hyperhidrosis."
