Technique of Robotic First Rib Resection—Tips and Pitfalls
Robotic resection of the first rib (R-FRR) in patients with thoracic outlet syndrome (TOS) was described in 2012 by Gharagozloo et al. (1). This group has published the results of their experience in the decade since the original description (2–8). Their most recent report included 162 patients—eighty-three for venous thoracic outlet syndrome (VTOS) and seventy-nine for neurogenic thoracic outlet syndrome (NTOS)—with a median hospital stay of three days (range: 2–4) for NTOS and a median stay of four days in patients with Paget-Schroetter syndrome.
In patients with NTOS, the QuickDASH scores were reduced significantly in the immediate postoperative period (5 ± 2.3) and at six months (3.5 ± 1.1) compared to the mean preoperative values of 50.3 ± 2.1 (p < 0.0001). Seventy-one out of seventy-nine (91%) of the NTOS patients reported that their symptoms were completely resolved in the immediate postoperative period and only three out of seventy-nine (3.8%) of them continued to have symptoms at six months. The entirety of patients with Paget-Schroetter syndrome had a patent subclavian vein in dynamic MRA—even two years postoperatively. These favorable findings were reproduced by other investigators who also showed reduced incidence of morbidity, zero mortality, and significant improvement of symptoms in NTOS and rates of subclavian vein patency (9–16).
The results derive from, one, a better understanding of the pathogenesis of TOS and, two, the technical advantages of the robotic platform.
This video presents the state-of-the-art understanding of TOS, narrates the technique of robotic first rib resection with tips and pitfalls, and presents the data from the therapeutic application of this technique to patients with TOS.
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