Robotic-Assisted First Rib Resection: Our Experience and Review of the Literature.

OBJECTIVE Thoracic outlet syndrome (TOS) comprises a constellation of signs and symptoms that arise from neurologic and vascular compression of the brachial plexus and subclavian vasculature, respectively. Surgical decompression of the neurovascular structures is often indicated to alleviate TOS. We report here our robotic surgical approach and experience for resection of the first rib. METHODS Between July 2014 and January 2017, seventeen patients who underwent robotic-assisted first rib resection at our institution were reviewed. RESULTS Nine women and eight men with a mean age of 45±11 years had a robotic-assisted first rib resection; eight for neurogenic thoracic outlet syndrome and nine for venous thoracic outlet syndrome. There were no complications or conversion to open surgery. The mean operative time was 113.2±55.3 minutes. Length of stay was a mean of 1.8±1.9 days. Length of rib resected was 5.8±0.5 cm. Anticoagulation for the venous TOS cohort was Xarelto, for a mean of 5.1±1.8 months. Short-term follow-up (mean 10.3±4.9 days) revealed resolution of symptoms in all patients, with patent vasculature on venogram for the entire venous TOS cohort. Further follow-up at two months and six months revealed that all patients remained symptom free. CONCLUSIONS Based on our institution's experience with the robotic-assisted approach to first rib resection, we feel that it is a feasible approach that could be added to the armamentarium of the thoracic surgeon.