Endoscopic assisted transaxillary first rib resection

Endoscopic assisted transaxillary first rib resection is a novel approach in the management of thoracic outlet syndrome. It allows safe identification of the different structures. The objective of our study is to assess the outcome of surgical treatment of thoracic outlet syndrome using this technique.

Between May 1999 and October 2005, 28 endoscopic assisted transaxillary first rib resections were performed on 20 patients with thoracic outlet syndrome in our vascular unit. This retrospective study included 14 females and 6 males with ages ranging between 16 and 53 years (median 37 years).

Prior to the operation, all patients had C spine X-ray and 45% (nine patients) had nerve conduction studies prior to the operation. Duration of symptoms ranged between 1 month and 15 years (median 36 months). Fifty-five percent of patients had neurological symptoms, 30% had mixed symptoms and only 15% had venous or arterial symptoms. Eight patients were given bilateral first rib excision. The average time between the two operations was 17.5 months (median 12 months). The postoperative stay in hospital ranged between 2 and 8 days (median 5 days). Follow-up ranged between 1 and 64 months (median 8 months). Eighty-two percent of patients (23 resections) had complete resolution of symptoms. Eighteen percent (5 resections) did not show any improvement of symptoms following surgery. Three complications were recorded, including haemothorax, bleeding and brachial plexus injury. The latter was due to traction injury during the operation.

Endoscopic assisted transaxillary first rib resection is a safe and effective procedure in the management of thoracic outlet syndrome. It also offers a great opportunity for teaching.