International Society For Minimally Invasive Cardiothoracic Surgery

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Robotic Thoracoscopic First Rib Resection For Neurogenic Thoracic Outlet Syndrome
Farid Gharagozloo, MD, Mark Meyer, Stephan Gruessner, Barbara Tempesta.
Florida Hospital Celebration Health/ University of Central Florida, Celebration, FL, USA.

Background: In the absence of a cervical rib, Neurogenic Thoracic Outlet Syndrome (NTOS) has been shown to result from compression of the subclavian vein by a congenitally abnormal portion of the medial aspect of the first rib at the sternocostal joint. We report our experience with robotic first rib resection in patients with NTOS. Methods: Patients diagnosed with NTOS underwent robotic resection of the offending portion of the first rib. All patients with a history of upper quadrant pain and other neurologic symptoms suspected of NTOS ,underwent physical exam with maneuvers, MRI of the cervical spine, complete orthopedic and neurologic examination, nerve conduction studies and Magnetic Resonance Angiography (MRA) with maneuvers. Patients with compression of the subclavian vessels with arm elevation on MRA were offered resection of the offending portion of the first rib. The robot was used to dissect the first rib and divide the scalene muscles. Success of the first rib resection was assessed by subjective symptom relief, physical exam, and postoperative MRA. Results: 79 robotic first rib resections were performed (29 men and 50 women). Mean age was 34 years +/- 9.5 years. Operative time was 87.6 minutes +/- 10.8 minutes. Median hospitalization was 3 days. There were no surgical complications, neurovascular injuries, or mortality. 75/79 (95%) patients had compression of the subclavian vein, 4 (5%)patients had compression of both the subclavian vein and artery. 72/79 ( 91%) patients reported complete subjective relief of upper quadrant symptoms immediately following surgery, 7/79 (9%) patients experienced upper extremity paresthesia for up to 3 weeks following surgery. At One month following surgery all patients reported complete symptom relief. Post procedure MRA showed patent subclavian vein with relief of extrinsic compression in all patients. Conclusions: Robotic transthoracic first rib resection is feasible and allows for a minimally invasive resection of the first rib in patients with Neurogenic Thoracic Outlet Syndrome while minimizing neurovascular complications.

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