ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
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Totally Endoscopic Treatment Of Thoracic Outlet Syndrome
Sofoklis Mitsos, Davide Patrini, Sara Velo, Martin Hayward, Robert George, David Lawrence, Nikolaos Panagiotopoulos.
University College London Hospitals(UCLH) NHS Foundation Trust, London, United Kingdom.

Objective:
Thoracic outlet syndrome (TOS) is a condition arising from compression of the subclavian vessels and/or brachial plexus as the structures travel from the thoracic outlet to the axilla. TOS may be classified as neurogenic TOS (NTOS) and vascular: venous TOS (VTOS), or arterial TOS (ATOS). The basis for the surgical treatment of TOS is resection of the first rib, and it may be combined with scalenectomy or cervical rib resection. Herein, we report a case of thoracic outlet syndrome which was successfully treated with totally endoscopic video-assisted thoracoscopic surgery (VATS) first rib resection.
Methods:
A 56 year old lady presented with a severe right anterior chest pain radiating her arm and back, with arm paresthesia , following a fall and rib injury few months ago. Diagnosis of TOS was based on clinical history, a physical examination, and additional diagnostic studies . MRI confirmed compression in her right subclavian artery and in the intascalene triangle distally even in the adduction. She underwent VATS first rib resection following failure of symptom improvement with physiotherapy. Three standard VATS ports were utilized. The first rib is identified, and both the parietal pleura and periosteum overlying it are stripped off. The rib was resected completely with endoscopic rib cutter. All periostal remnants were trimmed releasing the neurovascular bundle completely.
Results:
The postoperative course was uncomplicated and patient was discharged within 24 hours following surgery in good conditions. At follow-up, patient had significant improvement of her main symptoms
Conclusions:
Complete thoracoscopic first rib resection provides superior visualization due to the magnified video-assisted thoracoscopic view, and perfect illumination by the scope allowing complete resection of the first rib. It results also in patient cosmetic satisfaction and reduced postoperative pain


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