Endoscopic Surgery for Thoracic Outlet Syndrome

The author typically diagnoses thoracic outlet syndrome (TOS) using ultrasonography and enhanced computed tomography (CT) in addition to various physical examination maneuvers. In particular, stenosis between the anterior and middle scalene muscles, changes in blood flow in the subclavian artery, stenosis of the subclavian artery, or narrowing of the intercostal space are essential findings in the diagnosis of TOS. Conservative therapy, mainly rehabilitation, is effective for TOS. However, surgery is performed in young patients with apparent morphological abnormalities. If the costoclavicular space is tight, the author resects the first rib. However, if the costoclavicular space is vast, the author releases the anterior and middle scalene muscles, leaving the first rib intact. (This is a translation of Jpn J Vasc Surg 2025; 34: 181-186.).