The Role of Robotic Surgery in Defining Pathogenesis, Diagnosis, and Modern Treatment of Thoracic Outlet Syndrome

Robotic surgery has been a transformative force in minimally invasive thoracic surgery. Robotic surgical technology has impacted surgery of the lung, mediastinum, esophagus, and the sympathetic chain. However, in one area of thoracic surgery, surgery for Thoracic Outlet Syndrome, robotics has not only impacted the minimally invasive surgical approach to the resection of the first rib, but it has allowed for a better understanding of the pathogenesis of the disease. Historically, the only consistent aspects of Thoracic Outlet Syndrome (TOS) have been the confusion among medical practitioners, difficulty in making the diagnosis, and poor results with surgical intervention. The present understanding of TOS is that it is the manifestation of a congenital malformation of the first rib where an abnormal boney tubercle at the costo-sternal joint results in compression of the subclavian vein (SV) at its junction with the innominate vein. The compression of the SV leads to a spectrum of diseases, which range from neurologic symptoms resulting from venous congestion of the upper extremity nerves to thrombosis of the SV with prolonged compression. Robotic technology allows for the precise removal of the “offending portion” of the first rib. This technique is associated with the best-reported results in patients with TOS.