Thoracic outlet syndrome: a retrospective analysis of robotic assisted first rib resections.

Azenha, Luis Filipe; Kocher, Gregor; Kestenholz, Peter B; Gioutsos, Konstantinos; Minervini, Fabrizio (2023). Thoracic outlet syndrome: a retrospective analysis of robotic assisted first rib resections. Journal of robotic surgery, 17(3), pp. 891-896. Springer 10.1007/s11701-022-01486-7

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Thoracic Outlet Syndrome (TOS) is caused by compression of the neurovascular bundle between the first rib and the clavicula, which can cause a large panel of symptoms and has a reported incidence of approximately 2-4/100.000. Surgical treatment consists of the resection of the first rib and is historically performed using an open, mainly transaxillary, approach. Recent developments resulted in a minimally invasive approach using Robotic Assisted Thoracic Surgery (RATS). With this study, the investigators want to provide a descriptive study of first rib resection using RATS approach at two different centers. We reviewed the files of 47 patients affected by TOS and who benefited from first rib resection using RATS approach between 2016 and 2021. Patient characteristics as well as Length of Stay (LOS), affected side, operative time (OT), complications, etiology, VAS score and post-operative QOL were gathered in the database. Statistical analysis was performed using IBM SPSS statistics 25 ®. Results were reported in mean and standard deviation. 47 patients affected by TOS received first rib resection using robotic approach. Mean age was 47 ± 12 yrs. 16 patients were operated on the left side and 31 on the right side. All the patients reported complete resolution of symptoms. At 1-year follow-up, no patient suffered from recurrence. There were no intraoperative complications. Postoperative complications occurred in two patients, one patient developed pneumothorax after chest tube removal and one patient developed recurrent pleural effusion which required surgery. Mean LOS was 3 ± 1 days and mean OT was 122 ± 40 min. First rib resection performed using a RATS approach is a safe technique with excellent outcomes and which is beneficial for the patient in terms of LOS, pain and symptom resolution.

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