Page 385 - Read Online

Gharagozloo et al. Mini-invasive Surg 2021;5:39 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.74

Technical Note Open Access

Technique of robotic first rib resection for thoracic

outlet syndrome

Farid Gharagozloo, Nabhan Atiquzzaman, Mark Meyer, Scott Werden
Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health Celebration, University of Central Florida,
Celebration, FL 34786, USA.

Correspondence to: Dr. Farid Gharagozloo, Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health
Celebration, University of Central Florida, 400 Celebration Place, Celebration, FL 34786, USA. E-mail: Gharagozloof@aol.com

How to cite this article: Gharagozloo F, Atiquzzaman N, Meyer M, Werden S. Technique of robotic first rib resection for thoracic
outlet syndrome. Mini-invasive Surg 2021;5:39. https://dx.doi.org/10.20517/2574-1225.2021.74

Received: 7 Jun 2021 First Decision: 14 Jul 2021 Revised: 15 Jul 2021 Accepted: 23 Jul 2021 First online: 24 Jul 2021

Academic Editor: Giulio Belli Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
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.

Keywords: Robotic Surgery, first rib resection, thoracic outlet syndrome, neurogenic, venous, paget schroetter

INTRODUCTION
[1]
Thoracic Outlet Syndrome (TOS) is highly underdiagnosed and undertreated . It is estimated that TOS
affects 0.3 to 8% of the population. This high variance in the reported prevalence reinforces the challenges in
terms of understanding TOS. Any discussion about TOS always begins with the classification that dates
back to the 1950s: Neurogenic (NTOS), Venous (Paget Schroetter Syndrome, PSS), and Arterial TOS .
[2]

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.misjournal.net