scholarly journals Robotic-Assisted Thoracoscopic Resection of the First Rib for Vascular Thoracic Outlet Syndrome: The New Gold Standard of Treatment?

2021 ◽  
Vol 10 (17) ◽  
pp. 3952
Author(s):  
Adrian Zehnder ◽  
Jon Lutz ◽  
Patrick Dorn ◽  
Fabrizio Minervini ◽  
Peter Kestenholz ◽  
...  
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Scar Tissue ◽  
Neurovascular Bundle ◽  
Surgical Approaches ◽  
Perioperative Morbidity ◽  
Stent Grafting ◽  
Camera Port ◽  
Venous Compression ◽  
First Rib ◽  
First Rib Resection

In thoracic outlet syndrome (TOS) the narrowing between bony and muscular structures in the region of the thoracic outlet/inlet results in compression of the neurovascular bundle to the upper extremity. Venous compression, resulting in TOS (vTOS) is much more common than a stenosis of the subclavian artery (aTOS) with or without an aneurysm. Traditional open surgical approaches to remove the first rib usually lack good exposure of the entire rib and the neurovascular bundle. Between January 2015 and July 2021, 24 consecutive first rib resections for venous or arterial TOS were performed in 23 patients at our institutions. For our completely portal approach we used two 8mm working ports and one 12/8 mm camera port. Preoperatively, pressurized catheter-based thrombolysis (AngioJet®) was successfully performed in 13 patients with vTOS. Operative time ranged from 71–270 min (median 128.5 min, SD +/− 43.2 min) with no related complications. The chest tube was removed on Day 1 in all patients and the hospital stay after surgery ranged from 1 to 7 days (median 2 days, SD +/− 2.1 days). Stent grafting was performed 5–35 days (mean 14.8 days, SD +/− 11.1) postoperatively in 6 patients. The robotic approach to first rib resection described here allows perfect exposure of the entire rib as well as the neurovascular bundle and is one of the least invasive surgical approaches to date. It helps improve patient outcomes by reducing perioperative morbidity and is a procedure that can be easily adopted by trained robotic thoracic surgeons. In particular, patients with a/vTOS may benefit from careful and meticulous preparation and removal of scar tissue around the vessels.

Surgical treatment of thoracic outlet syndrome: a randomized trial comparing two operations

2005 ◽  
Vol 3 (5) ◽  
pp. 355-363 ◽  
Author(s):  
Rishi N. Sheth ◽  
James N. Campbell
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Clinical Problem ◽  
Surgical Approaches ◽  
Content Type ◽  
Rib Resection ◽  
First Rib ◽  
Supraclavicular Fossa ◽  
First Rib Resection ◽  
Fine Print

Object. Various surgical approaches have been proposed for the treatment of thoracic outlet syndrome (TOS). The authors of this study focused on the differences in outcome after supraclavicular neuroplasty of brachial plexus (SNBP [no rib resection]) and transaxillary first rib resection (TFRR) in patients in whom the dominant clinical problem was pain. Methods. Fifty-five patients were randomized to undergo TFRR or SNBP. Patients with an anomalous cervical rib, intrinsic weakness, and primarily vascular findings were excluded from the study. Preoperatively, the following findings were typically observed: provocation of symptoms by certain postures (the so-called spear-throwing position as well as downward tugging of the shoulder) and marked tenderness in the supraclavicular fossa. The intergroup severity of the symptoms was comparable. Eight patients were lost to follow up. There were 24 TFRRs (in two cases the procedure was bilateral) and 25 SNBPs. The mean follow-up interval was 37 months. In both groups pain decreased significantly after surgery. By all measures the TFRR operation conferred superior results. Patients reported significantly less pain (39 ± 7 compared with 61 ± 7; score range 0–100 on a visual analog scale), greater percentage of pain relief (52 ± 8% compared with 30 ± 7%), and less pain (3.7 ± 0.4 compared with 5.1 ± 0.5) on an affective scale (all p < 0.05) in the TFRR and SNBP groups, respectively). In the TFRR group, 75% of patients reported good or excellent outcomes compared with 48% in the SNBP group (p < 0.05). Conclusions. Transaxillary first rib resection provided better relief of symptoms than SNBP. The major compressive element in patients with TOS-associated pain appeared to be the first rib.

scholarly journals Morbidity of First Rib Resection in the Surgical Repair of Thoracic Outlet Syndrome

Hand ◽  
2018 ◽  
Vol 14 (5) ◽  
pp. 636-640 ◽  
Author(s):  
Kevin T. Jubbal ◽  
Dmitry Zavlin ◽  
Joshua D. Harris ◽  
Shari R. Liberman ◽  
Anthony Echo
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Operative Time ◽  
Medical Complications ◽  
Complication Rates ◽  
Improvement Program ◽  
Cervical Rib ◽  
Rib Resection ◽  
First Rib ◽  
Increased Risk ◽  
First Rib Resection

Background: Thoracic outlet syndrome (TOS) is a complex entity resulting in neurogenic or vascular manifestations. A wide array of procedures has evolved, each with its own benefits and drawbacks. The authors hypothesized that treatment of TOS with first rib resection (FRR) may lead to increased complication rates. Methods: A retrospective case control study was performed on the basis of the National Surgical Quality Improvement Program database from 2005 to 2014. All cases involving the operative treatment of TOS were extracted. Primary outcomes included surgical and medical complications. Analyses were primarily stratified by FRR and secondarily by other procedure types. Results: A total of 1853 patients met inclusion criteria. The most common procedures were FRR (64.0%), anterior scalenectomy with cervical rib resection (32.9%), brachial plexus decompression (27.2%), and anterior scalenectomy without cervical rib resection (AS, 8.9%). Factors associated with increased medical complications included American Society of Anesthesiologists (ASA) classification of 3 or greater and increased operative time. The presence or absence of FRR did not influence complication rates. Conclusions: FRR is not associated with an increased risk of medical or surgical complications. Medical complications are associated with increased ASA scores and longer operative time.

scholarly journals Specialty Mediated 30-Day Complications in First Rib Resection for Thoracic Outlet Syndrome

2021 ◽  
Vol 74 (6) ◽  
pp. 2115
Author(s):  
R. Sorber ◽  
M.L. Weaver ◽  
J.K. Canner ◽  
B. Campbell ◽  
J.H. Black ◽  
...  
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Rib Resection ◽  
First Rib ◽  
First Rib Resection

First Rib Resection for Thoracic Outlet Syndrome: The Robotic Approach

2018 ◽  
Vol 42 (10) ◽  
pp. 3250-3255 ◽  
Author(s):  
Gregor J. Kocher ◽  
Adrian Zehnder ◽  
Jon A. Lutz ◽  
Juerg Schmidli ◽  
Ralph A. Schmid
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Robotic Approach ◽  
Rib Resection ◽  
First Rib ◽  
First Rib Resection

Thoracic Outlet Syndrome: The Results of First Rib Resection in 100 Patients

1988 ◽  
Vol 19 (1) ◽  
pp. 131-146 ◽  
Author(s):  
Virchel E. Wood ◽  
Randy Twito ◽  
Joseph Michael Verska
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Rib Resection ◽  
First Rib ◽  
First Rib Resection

Arterial Thoracic Outlet Syndrome

2018 ◽  
Author(s):  
Besem Beteck ◽  
John Eidt ◽  
Bradley Grimsley
Keyword(s):  
Subclavian Artery ◽  
Thoracic Outlet Syndrome ◽  
Computed Tomographic Angiography ◽  
Rib Resection ◽  
Computed Tomographic ◽  
First Rib ◽  
Arterial Complication ◽  
Scalene Triangle ◽  
First Rib Resection ◽  
Arterial Thoracic Outlet Syndrome

Arterial thoracic outlet syndrome (TOS) is the least common form of TOS in adults. It is an entity that is associated with bony anomalies resulting in chronic subclavian artery compression. Most patients with arterial TOS are young adults presenting either with limb-threatening upper extremity ischemia or chronic symptoms suggestive of arterial insufficiency involving the extremity. Initial diagnostic evaluation involves chest radiography, which may reveal cervical or anomalous first rib. Catheter-based arteriography has a diagnostic as well as therapeutic role. Magnetic resonance angiography and computed tomographic angiography, which are readily available, can be used in surgical planning. Treatment involves revascularization of the extremity, subsequent first rib resection, and possible reconstruction of the subclavian artery. This review contains 4 figures, 1 table and 45 references Key Words: arterial complication, brachial thromboembolectomy, cervical rib, costoclavicular space, first rib resection, pectoralis minor space, scalene triangle, subclavian artery stenosis, thoracic outlet syndrome

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