Thoracic Outlet Syndrome: Single Center Experience on Robotic Assisted First Rib Resection and Literature Review.

Fabrizio Minervini,Gregor Jan Kocher,Davide Patrini,Savvas Lampridis,Marco Scarci,Peter B. Kestenholz,Luis Filipe Azenha,Andreas Gkikas

doi:10.3389/fsurg.2022.848972

Abstract

BackgroundThoracic outlet syndrome (TOS) is a pathological condition caused by a narrowing between the clavicle and first rib leading to a compression of the neurovascular bundle to the upper extremity. The incidence of TOS is probably nowadays underestimated because the diagnosis could be very challenging without a thorough clinical examination along with appropriate clinical testing. Beside traditional supra-, infraclavicular or transaxillary approaches, the robotic assisted first rib resection has been gaining importance in the last few years.MethodsWe conducted a retrospective cohort analysis of all patients who underwent robotic assisted first rib resection due to TOS at Lucerne Cantonal Hospital and then we performed a narrative review of the English literature using PubMed, Cochrane Database of Systematic Reviews and Scopus.ResultsBetween June 2020 and November 2021, eleven robotic assisted first rib resections were performed due to TOS at Lucerne Cantonal Hospital. Median length of stay was 2 days (Standard Deviation: +/– 0.67 days). Median surgery time was 180 min (Standard Deviation: +/– 36.5). No intra-operative complications were reported.ConclusionsRobotic assisted first rib resection could represent a safe and feasible option in expert hands for the treatment of thoracic outlet syndrome.

Highlights

Thoracic Outlet Syndrome (TOS) includes a variety of disorders that cause compression of neurovascular structures as they travel from the posterior triangle of the neck to the axilla [1]
At 2 weeks post-operative follow up all the patients had a total resolution of symptoms with a mean self-reported Pain visual analog scale (VAS) score of 0.6 (Standard Deviation: +/– 1.99)
Results from solely Venous Thoracic Outlet Syndrome reported in red, results from solely Neurogenic Thoracic Outlet Syndrome reported in black, solely Arterial Thoracic Outlet Syndrome reported in green

Summary

Introduction

Thoracic Outlet Syndrome (TOS) includes a variety of disorders that cause compression of neurovascular structures as they travel from the posterior triangle of the neck to the axilla [1]. This can result in subclinical manifestations to even debilitating symptoms in the upper extremity. The prevalence of TOS in the general population should be interpreted with caution due to lack of epidemiological data in the literature [1, 2]. It is commonly diagnosed in young adults aged 20–50 years and affects women 3–4 times more frequently than men [3–6]. Beside traditional supra-, infraclavicular or transaxillary approaches, the robotic assisted first rib resection has been gaining importance in the last few years

Methods

Results

Conclusion