Long-Term Quality of Life Comparison between Supraclavicular and Infraclavicular Rib Resection in Patients with vTOS

When Healing Hands Hurt: Epidemiology of Thoracic Outlet Syndrome Among Physicians

“…Lee noted DASH scores reduced from 36 to 4.9 and 91% return to baseline activity. 13 We identified initial patency of 88% and late patency of 77% this was accompanied by a 35point reduction in DASH scores. All our patients resumed their normal daily work and activities following FRR.…”

A Novel Approach to First-Rib Resection in Neurogenic Thoracic Outlet Syndrome

“…The most outstanding advantage of piezo surgery is its soft tissue protective effect. Owing to the close relationship between the first rib and soft tissues ( 8 ), traditional FRR via the supraclavicular approach is usually associated with soft tissue injury, including pneumothorax ( 9 , 10 ), neurovascular bundle injury ( 18 , 36 ), sympathetic chain injury ( 9 ), and lymph leakage ( 11 – 16 ). In our study, there were no reports of soft tissue injury in the piezo surgery group.…”

“…Previous studies defined first-rib resection (FRR) as the most demanding and potentially dangerous component of TOS surgery (6,7). A close relationship between the first rib and soft tissue can be associated with soft tissue injury, including pneumothorax (with an incidence of 2.5-10%), lymph leakage (incidence of 2-9.3%), and nerve injury (incidence of 11%) (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Therefore, several methods for the minimal invasive resection of the first rib have been reported including video assisted thoracic surgery (VATS), and robotic-assisted thoracic surgery (19,20).…”

Surgical Approaches for Thoracic Outlet Syndrome: A Review of the Literature

“…Furthermore, the neurovascular bundle is retracted to obtain good visualization. Neurological complications, including nerve traction injury, are common with the transaxillary approach, and occur in 4 Success rate: 77%, Complete relief rate: 57% Supraclavicular scalenectomy without first-rib excision (n ¼ 674; systematic review) 4 Success rate: 85% Complete relief rate: 61% Infraclavicular (n ¼ 55; case-control study) 11 Patency rate of subclavian vein: 95% Posterior (n ¼ 2,305; case series) 12 Good, 75%; fair, 16%; poor, 9% Combined transaxillary and supraclavicular (n ¼ 94; case-control study) 13 Excellent, 95%: good, 4%; poor, 1% Combined supraclavicular and infraclavicular (n ¼ 100; case series) 14 Derkash score: excellent, 41%; good, 35%; fair, 19%; poor, 5% Endoscopic-assisted transaxillary (n ¼ 131; case series) 6 Roos and Derkash score: excellent, 40%; good, 41%; fair, 14%; poor, 6% Video-assisted thoracoscopic (n ¼ 30; case-control study) 8 Excellent, 37%; good, 30%; partial, 20%; no significant improvement, 13% 4 Pleural opened or pneumothorax: 19% Neurological injury: 3% Vascular injury: 0.3% (3 veins, 1 artery) Death: 0.07% (1 case) Supraclavicular scalenectomy without first rib excision (n ¼ 674; systematic review) 4 Pleural opened or pneumothorax: 5% Neurological injury: 7% Vascular injury: 0.2% (1 vein) Death: 0% Infraclavicular (n ¼ 55; case-control study) 11 Pneumothorax: 7% Neurological injury: 0% Posterior (n ¼ 2,305; case series) 12 Pleural opened: most cases (unknown rate) Neurological injury: unknown rate Combined transaxillary and supraclavicular (n ¼ 94; case-control study) 13 Pneumothorax: 4% Neurological (phrenic nerve) injury: 1% Combined supraclavicular and infraclavicular (n ¼ 100; case series) 14 Pneumothorax: 0% Neurological injury: 6% Pleural effusion and hemothorax: 6% Endoscopic-assisted transaxillary (n ¼ 131; case series) 6 Pneumothorax: 3% Neurological (long thoracic and axially nerve) injury: 2% Video-assisted thoracoscopic (n ¼ 30; case-control study) 8 Pleural opened:100% Neurological (brachial plexus) injury: 3% approximately 5% of patients. 2,4 The reported rate of permanent brachial plexus injury is 0.1%.…”