Robotic Transthoracic First Rib Resection for Neurogenic Thoracic Outlet Syndrome ()
ABSTRACT
Purpose: Neurogenic Thoracic Outlet Syndrome accounts for over 95% of patients
with TOS. We report a single institution experience with robotic first rib
resection in patients with Neurogenic TOS. Methods: The diagnosis of
NTOS was made in patients in whom all specific localizing and diagnostic
orthopedic and neurologic conditions were ruled out. Preoperative diagnostic
tests included a comprehensive history and physical exam, Chest X-ray, Chest
CT, MRI if the cervical spine, Nerve conduction studies, and Magnetic Resonance
angiography of the Thoracic outlet with arm maneuvers (MRA). Patients with NTOS
who underwent robotic first rib resection with disarticulation of the
costosternal joint and scalenectomy. Results: There were 137 patients
(47 men and 90 women). Mean age was 34 ± 9.5 years. Operative time was 93
minutes ± 10.3 minutes. There were no intraoperative complications. There was
no injury to the subclavian vessels during the dissection. There were no
neurovascular complications. There was no 30 or 90 day mortality. Quick DASH
Scores (Mean ± SEM) decreased from 60.3+/2.1 preoperatively to 5 ± 2.3 in the
immediate postoperative period, and 3.5+/1.1 at 6 months. (P < 0.01)
Immediate relief of symptoms was seen in all patients (100%). Complete relief
of symptoms was seen in 133/137 (97%) of patients. Conclusions: Robotic
resection of the medial aspect of the first rib with disarticulation of the
costo-sternal joint is associated with excellent relief of neurologic symptoms
in patients with Neurogenic Thoracic Outlet Syndrome.
Share and Cite:
Gharagozloo, F. and Meyer, M. (2022) Robotic Transthoracic First Rib Resection for Neurogenic Thoracic Outlet Syndrome.
World Journal of Cardiovascular Surgery,
12, 1-11. doi:
10.4236/wjcs.2022.121001.