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Left Thoracoscopic First Rib Resection With Two Ports: Thoracic Outlet Syndrome

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posted on 20.01.2020 by Ignacio Sastre, Manuel España, Robert Ceballos, Mario E. F. Bustos

Thoracic outlet syndrome is a pathology caused by compression of the subclavian artery, subclavian vein, and/or brachial plexus. Its most effective treatment is the section of the scalene muscles, along with the removal of the first rib and section of adjacent ligaments. The authors show the first rib resection technique by videothoracoscopy.

A 35-year-old woman comes to the thoracic surgery department due to pain in the upper left limb, associated with paresthesia in the shoulder and forearm, which increases with abduction. She presents a Doppler ultrasound of both upper limbs, where there is evidence of compression of the left subclavian artery, with the arm abducted at the level of the thoracic outlet.

The authors describe the technique by videothoracoscopy through two ports: one of 10 mm for the video camera and another of 2 cm as a working port. The authors use this technique regularly with very good results. The videothoracoscopic or VATS approach to thoracic outlet syndrome provides, unlike classical approaches, an excellent visualization of all bone, vascular, and nervous structures in the area. It allows for the identification of the first rib in its entirety just by opening the parietal pleura. It also allows for the removal of the first rib in its entirety from the chondrocostal junction in the anterior area until its disintegration of the costovertebral joint. It also facilitates the section of the anterior and middle scalene muscle with perfect visualization of the artery, vein, and brachial plexus, making it safer, as well as improving control and preventing lesions on the sympathetic chain and the stellate ganglion. The authors add better management of postoperative pain and shorter hospital stay.

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