Robotic En Bloc First-Rib Resection for Paget-Schroetter Disease, a Form of Thoracic Outlet Syndrome Technique and Initial Results

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> First-rib resection is a key component of the treatment of Paget-Schroetter disease. There are many controversies regarding the management of this disease. We report a safe, effective, minimally invasive robotic transthoracic approach for resection of the first rib. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Over an 8-month period, five patients underwent robotic first-rib resection. Preoperative assessment included physical examination and bilateral venous angiography. On a thoracoscopic platform using three 2-cm incisions and one 1-cm incision, the robot was used to dissect the first rib and divide the scalene muscles. Success of the first-rib resection was assessed by postoperative venous angiography. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> There were four men and one woman. Mean age was 34.6 ± 10 years. Mean operative time was 195 ± 24.6 minutes. There were no complications and no mortality. All patients had a patent subclavian vein on the postoperative venogram and were anticoagulated with warfarin for 3 months. At a median follow-up of 12 months, all patients had an open subclavian vein for a patency rate of 100%. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Robotic thoracoscopic first-rib resection represents a feasible minimally invasive approach to en bloc resection of the first rib. This technique minimizes the risk of neurovascular complications that are associated with conventional techniques. </jats:p></jats:sec>

Novel Axillary Approach for Brachial Plexus in Robotic Surgery: A Cadaveric Experiment

“…Surgical approaches to first rib resection may be transthoracic, transaxillary, supraclavicular, infraclavicular, or thoracoscopic [9, 10]. However, these approaches are typically associated with incomplete resection of the most medial portion of the first rib and neurovascular complications [11]. Theoretically, a minimally invasive transthoracic approach can obviate these problems, enabling complete resection of the offending portion of the first rib without neurovascular complication.…”

“…Theoretically, a minimally invasive transthoracic approach can obviate these problems, enabling complete resection of the offending portion of the first rib without neurovascular complication. Gharagozloo et al and Martinez et al, respectively, reported successful results of robotic en bloc first rib resection for TOS treatment via transthoracic and transaxillary approaches [9, 11]. Gharagozloo et al and Martinez et al's techniques were only bony interventions and as being intrathoracic these need to be lung collapsed and lung complication can be waiting risk.…”

“…Martinez et al described first rib resection via robotic surgery but not to address plexus injury without transthoracic exposure, a novel minimally invasive approach to the first rib from inside of the chest [9]. In addition, Gharagozloo et al reported first rib resection via transthoracic robotic surgery for Paget-Schroetter disease [11]. Martinez et al's techniques were considered more useful for lower brachial plexus viewing and assessing according to Gharagozloo et al's but these two techniques describe only bony interventions.…”

New Diagnostic and Treatment Modalities for Neurogenic Thoracic Outlet Syndrome

“…At one-year follow-up, all patients maintained patent subclavian veins without any additional intervention. The average length of hospital stay was three days [27]. A later series from this institution evaluated the outcomes of robotic first rib resection for venous TOS in 13 patients and continued to demonstrate similar results with 100% vein patency at six months and a mean post-operative hospital stay of three days.…”

Videothoracoscopic surgery for thoracic outlet syndrome

“…Videotorakoskopik TOS cerrahisi uygulamalarına alternatif olarak, Gharagozloo ve arkadaşları 2012 yılında robotik TOS cerrahisini gündeme getirmişler, birinci kostanın mediyal 2/3 kısmının çıkartıldığı ve skalenotomi uyguladıkları 5 Paget-Schroetter olgusunda başarılı sonuçlarını bildirmişlerdir (5).…”