Trans-axillary First and Cervical Rib Resection - How I Do It

Thoracic outlet syndrome (TOS) remains a clinical enigma, with its management often being complex. The majority of the patients are managed with nonsurgical measures, including physiotherapy, analgesics, muscle relaxants, and Botox injections, with surgery being offered to those in whom symptoms persist or recur despite conservative management. In patients with symptomatic, nonarterial TOS, trans-axillary first (with or without cervical) rib resection is an excellent approach for thoracic outlet decompression. Although popularized by Roos, this approach is less commonly practiced today due to limited anatomic visibility and reduced familiarity among vascular surgeons. This paper outlines the surgical steps and provides practical insights for performing transaxillary first and/or cervical rib resection.