Technique of robotic first rib resection for thoracic outlet syndrome

Conventionally, resection of the first rib has been performed by the transaxillary and supraclavicular approaches. These approaches are hampered by poor visualization and exposure of the operative field, neurovascular complications, and less than optimal surgical outcomes. The Robotic Surgical System allows for high-definition, magnified, three-dimensional visualization of the operative field and is associated with accurate instrument maneuverability in a confined space. Importantly, the robotic transthoracic technique facilitates the disarticulation of the costo-sternal joint, which appears to be the most critical determinant of surgical success. Robotic first rib resection has been associated with the best-reported outcomes in patients with both Neurogenic and Venous (Paget Schroetter Syndrome) Thoracic Outlet Syndrome (TOS). This paper outlines the technique of robotic first rib resection with disarticulation of the costo-sternal joint for patients with TOS.