First Rib Resection for Thoracic Outlet Syndrome: The Robotic Approach

Kocher, Gregor J.; Zehnder, Adrian; Lutz, Jon A.; Schmidli, Juerg; Schmid, Ralph A.

doi:10.1007/s00268-018-4636-4

Cited by 36 publications

(30 citation statements)

References 25 publications

(19 reference statements)

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“…Through this incision a fi nger was placed to retract the rib. In this article a clip applier was used for this maneuver, only requiring three working ports [12].…”

Section: Discussionmentioning

confidence: 99%

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Robot-assisted First Fib Resection for Neurogenic Thoracic Outlet Syndrome

Beelen¹

2019

Ann Musculoskelet Med

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This pathophysiological mechanism forms the substrate of the surgical treatment of TOS (cf. infra). AbstractBackground: When conservative measures fail in the treatment of thoracic outlet syndrome (TOS), a fi rst rib resection (FRR) is in order. Nowadays, a transaxillary or supraclavicular approach is most commonly used. However, both techniques have technical limitations.Objective: In this paper a minimal invasive, robot-assisted thoracoscopic technique tackling those shortcomings is proposed. Methods:A single-center retrospective study including 11 patients with 12 FRR's from January 2017 until August 2018 was performed. The main focus was the feasibility of this new technique by looking at mean hospital stay, postoperative pain and complication rate. Clinical outcome was evaluated at 6 weeks.Results: Twelve FRR were performed in 10 women and 1 man. Average operative time was 99 ± 32 minutes. One patient needed chest tube replacement for pneumothorax after initial tube removal. One patient was readmitted for pleurisy which was treated conservatively. Max average pain score (VAS; visual analogue pain score) was 5. Mean hospital stay was 3.4 days. Outcome at 6 weeks' time showed a complete relief of symptoms in 8 cases. Three patients had some residual fatigue complaints. However, these complaints improved over time. In one case there was no real benefi t from the procedure. Conclusion:Robot-assisted thoracoscopic FRR is a safe and feasible method in the treatment of TOS with excellent postoperative results. A robot-assisted approach offers the benefi t of an excellent exposure of the operative fi eld and gentle handling of tissue. Further research in larger series is needed to compare this promising technique to conventional approaches.

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“…Through this incision a fi nger was placed to retract the rib. In this article a clip applier was used for this maneuver, only requiring three working ports [12].…”

Section: Discussionmentioning

confidence: 99%

“…During the writing of this article, this approach has been described in the treatment in vTOS (Paget-Schroetter disease) [7][8][9][10] and in the treatment of aTOS caused by a cervical rib [11]. Kocher et al recently published an article treating 4 cases of nTOS robotically (April 2018) [12].…”

Section: A New Approachmentioning

confidence: 99%

Robot-assisted First Fib Resection for Neurogenic Thoracic Outlet Syndrome

Beelen¹

2019

Ann Musculoskelet Med

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Section: Surgical Managementmentioning

confidence: 99%

“…Rib resections carry an inherent risk of neurovascular injury due to poor visualization and incomplete resection [101][102][103]. The use of robotically assisted endoscopic cameras allows for improved visualization of the first rib and the neurovascular bundle, although it is unclear whether this procedure is correlated with stronger symptomatic and postoperative outcomes [101]. Other studies have discussed the advantages of minimally invasive surgical approaches to symptomatic TOS; robotically assisted transthoracic cervical rib resections are associated with improved postoperative wound healing, decreased neurologic complications, and cosmetically favorable scar formation [104,105].…”

Section: Surgical Managementmentioning

confidence: 99%

Thoracic Outlet Syndrome: A Narrative Review

Dierks

Vervaeke

et al. 2021

JCM

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Thoracic outlet syndrome comprises a group of disorders that result in compression of the brachial plexus and subclavian vessels exiting the thoracic outlet. Symptoms include pain, paresthesia, pallor, and weakness depending upon the compromised structures. While consensus in diagnostic criteria has not yet been established, a thorough patient history, physical exam, and appropriate imaging studies are helpful in diagnosis. General first-line therapy for thoracic outlet syndrome is a conservative treatment, and may include physical therapy, lifestyle modifications, NSAIDs, and injection therapy of botulinum toxin A or steroids. Patients who have failed conservative therapy are considered for surgical decompression. This article aims to review the epidemiology, etiology, relevant anatomy, clinical presentations, diagnosis, and management of thoracic outlet syndrome.

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“…Therefore, this procedure is associated with recurrence and complications to some degree [8][9][10][11][12] . Endoscopically assisted rst rib resection and robotically assisted thoracoscopic rst rib resection have reduced the incidence of these complications [13][14][15][16][17][18][19] .…”

Section: Introductionmentioning

confidence: 99%

Arthroscopy-assisted First Rib Resection and Brachial Plexus Neurolysis for Thoracic Outlet Syndrome

Satake

Honma

Nito

et al. 2021

Preprint

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The present study included 27 consecutive patients (30 limbs) undergoing arthroscopy-assisted transaxillary first rib resection and brachial plexus neurolysis for thoracic outlet syndrome (TOS). To improve visualization, we changed the intraoperative limb position in three stages. We assessed the intraoperative parameters, including the scalene interval width between the anterior and middle interscalene muscles (interscalene base), blood loss, operation time, preoperative and postoperative QuickDASH, patient satisfaction, and complications. The mean intraoperatively measured interscalene base width was 6.2 mm. Appropriate visualization could be obtained at zero-position in the late phase. Intraoperative blood loss and operation time were significantly less in the late phase (p < 0.001). The QuickDASH score was significantly improved (42 before surgery vs. 9 at final follow-up, p < 0.001), especially in athletes relative to non-athletes (0.2 vs 14, p < 0.001). The outcome was excellent in 43.3% of cases, good in 43.3%, fair in 13.3%, and poor in none. The present approach achieved complete relief in 43% of cases overall (91% in athletes and 16% in non-athletes). Pneumothorax was present at the early phase in 3.3%. There were no other complications and no recurrences. Arthroscopic surgery is useful for TOS, especially in athletes.

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First Rib Resection for Thoracic Outlet Syndrome: The Robotic Approach

Cited by 36 publications

References 25 publications

Robot-assisted First Fib Resection for Neurogenic Thoracic Outlet Syndrome

Robot-assisted First Fib Resection for Neurogenic Thoracic Outlet Syndrome

Thoracic Outlet Syndrome: A Narrative Review

Arthroscopy-assisted First Rib Resection and Brachial Plexus Neurolysis for Thoracic Outlet Syndrome

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