When a sympathectomy results in the body starting to sweat copiously at another location, compensatory sweating; the cause of this change isn’t fully understood. Consequently it should not be surprising that the results of a graft to reverse a sympathectomy are not always fully predictable. The procedure is still relatively new and there are questions about the permanency of the graft, the regeneration of appropriate nerve signals, and whether the body will develop other side effects.

How the lung is accessed matters a great deal. A robotic minimally invasive surgery leaves only tiny incisions, which heal more quickly and with less pain. The fine motor control of the robotic instruments makes it possible to perform certain actions, such as lymph node dissection, one of the typical surgical procedures for the lobectomy, with greater precision and speed than if it were done by hand. The end result is that while a robotic lobectomy usually requires at least as much time as an open procedure, it is generally less traumatic to the patient.

For the patient undergoing a robotic assisted thymectomy, the biggest advantages accrue from the minimally invasive approach and the precision of the internal surgical work. The difference in recovery between an operation that requires four or five small incisions on the side of the chest versus an operation that requires cutting through the sternal bone is enormous. The result is that multiple studies throughout the world now suggest the robotic technique has similar effectiveness and remission rates as the transsternal approach.

Sublobar lung resection and brachytherapy seed placement is gaining acceptance for T1 non-small cell lung cancer (NSCLC) in select patients with comorbidities precluding lobectomy. Our institution first reported utilization of the da Vinci system for robotic brachytherapy developed experimentally and later applied to high-risk patients. Robotic brachytherapy seed placement is a feasible adjuvant procedure to reduce the incidence of recurrence after sublobar resection in medically compromised patients.

Achalasia is a problem with the nerve cells that transmit messages to the esophageal musculature characterized by increased lower esophageal sphincter (LES) pressure, diminished or absent peristalsis in the distal portion of the esophagus composed of smooth muscle, and lack of a coordinated LES relaxation in response to swallowing. The ultimate cause of this degeneration is unknown. Autoimmune disease or hidden infection is suspected.