Completely Thoracoscopic 3-Port Robotic First Rib Resection for Thoracic Outlet Syndrome

Background: In thoracic outlet syndrome, the constriction between bony and muscular structures leads to compression of the neurovascular bundle to the upper extremity. Traditional surgical techniques using supraclavicular, infraclavicular, or transaxillary approaches to remove the first rib do not usually allow good exposure of the entire rib and neurovascular bundle. We have therefore developed a robotic approach to overcome these limitations. Methods: Between January 2015 and November 2020, 38 consecutive first rib resections for neurogenic, venous, or arterial thoracic outlet syndrome were performed in 34 patients at our institutions. For our completely portal approach, we used two 8-mm working ports and one 12-mm camera port. Results: The surgery time was between 71 and 270 minutes (median ± SD: 133 ± 44.7 minutes) without any complications. Chest tube was removed on postoperative day 1 in all patients and the hospital stay after surgery ranged from 1-7 days (2 ± 2.1 days). No relevant intraoperative or postoperative complications were observed and complete or subtotal resolution of symptoms was seen in all patients. Conclusions: The robotic technique described here for first rib resection has proven to be a safe and effective approach. The unsurpassed exposure of the entire first rib and possibility for a robotic-assisted meticulous surgical dissection has prevented both intraoperative and postoperative complications. This makes this technique unique as the safest and most minimally invasive approach to date. It helps improve patient outcomes by reducing perioperative morbidity with an easily adoptable procedure.