Technique of robotic first rib resection for thoracic outlet syndrome

Abstract

Conventionally, resection of the first rib has been performed by the transaxillary and supraclavicular approaches. These approaches are hampered by poor visualization and exposure of the operative field, neurovascular complications, and less than optimal surgical outcomes. The Robotic Surgical System allows for high-definition, magnified, three-dimensional visualization of the operative field and is associated with accurate instrument maneuverability in a confined space. Importantly, the robotic transthoracic technique facilitates the disarticulation of the costo-sternal joint, which appears to be the most critical determinant of surgical success. Robotic first rib resection has been associated with the best-reported outcomes in patients with both Neurogenic and Venous (Paget Schroetter Syndrome) Thoracic Outlet Syndrome (TOS). This paper outlines the technique of robotic first rib resection with disarticulation of the costo-sternal joint for patients with TOS.

Thoracic Outlet Syndrome: Single Center Experience on Robotic Assisted First Rib Resection and Literature Review

“…These included the improved maneuverability of the instruments in narrow spaces, offering high-definition magnification and overall better-quality visualization of the operating field ( Figure 3 ). Therefore, Gharagozloo et al ( 71 ) introduced a procedure that combines the benefits of robotic-assisted surgery with the benefits of thoracoscopic surgery for FRR. Approaching the resection of the first rib from within the chest with RATS resulted in the design of a promising operation.…”

“…The same group of researchers have published 3 more reviews from their practice with R-FRR for TOS ( 26 , 49 , 71 ). In their most recent report ( 26 ), they included 162 patients (83 for VTOS and 79 for NTOS) with a median hospital stay of 3 days (Range: 2–4) for NTOS and median stay of 4 days in patients with Paget-Schroetter syndrome.…”

“…Similarly to many other aspects of TOS, there is no universally accepted surgical approach for excising the first rib. These can be categorized to open (10,(57)(58)(59)(60)(61), video-assisted (62)(63)(64)(65)(66)(67)(68)(69) and robotic-assisted procedures (12,26,(41)(42)(43)(70)(71)(72)(73)(74)(75)(76)(77). The traditional procedures for the treatment of FRR have been performed via open surgery using posterior thoracotomy (58,59), transaxillary (10), supra-or infra-clavicular approaches (61).…”