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Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome
Published on: September 13, 2020
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Robotic first rib resection for thoracic outlet syndrome
Farid Gharagozloo1, Nabhan Atiquzzaman1, Mark Meyer1
1Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health Celebration, University of Central Florida, Celebration, FL, USA.
Journal of Thoracic Disease
|November 19, 2021
Summary
Robotic first rib resection offers excellent outcomes for thoracic outlet syndrome (TOS). This minimally invasive approach effectively treats both venous (Paget-Schroetter syndrome) and neurogenic TOS with high success rates and no complications.
Area of Science:
- Minimally Invasive Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Thoracic outlet syndrome (TOS) encompasses neurogenic and venous forms, often caused by first rib compression.
- Traditional treatments have limitations; robotic surgery offers potential advantages.
- Improved understanding of TOS pathogenesis guides surgical intervention.
Purpose of the Study:
- To outline the current understanding of TOS pathogenesis.
- To report outcomes of robotic resection of the first rib for neurogenic and venous TOS.
- To evaluate the efficacy and safety of robotic-assisted first rib resection.
Main Methods:
- Robotic-assisted thoracoscopic resection of the "offending portion" of the first rib was performed.
- Diagnosis of TOS was confirmed using magnetic resonance angiography (MRA).
- 162 patients with TOS (83 venous, 79 neurogenic) underwent the procedure.
Main Results:
- For venous TOS (Paget-Schroetter syndrome), 100% subclavian vein patency was achieved at 24 months post-op, with no complications or mortality.
- For neurogenic TOS, Quick DASH scores significantly improved (60.3 to 3.5 at 6 months, P<0.0001).
- 91% of neurogenic TOS patients experienced immediate symptom relief, with minimal persistent paresthesia (3.8% at 6 months).
Conclusions:
- Robotic resection of the first rib is a safe and highly effective treatment for both venous and neurogenic TOS.
- The technical advantages of the robotic platform contribute to excellent patient outcomes.
- MRA-guided identification of the "offending portion" of the first rib is crucial for successful surgical intervention.
