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3. Vascular injury: care should be taken to stay away from the subclavian vessels by remaining close to the
bone. The surgical robot does not allow the use of two hook instruments. Therefore during this phase, the
hook in the right robotic arm needs to be connected to an external cautery power source. The left hook pulls
down on the bone, and the right hook “hugs” the bone. We have never had a vascular injury. However, we
are always prepared and run team drills in a regular interval. Based on laboratory studies, the best way to
control bleeding from the subclavian vein is to use the technique that we have previously described for
control of major vascular injury during robotic lobectomy .
[16]

Conclusion
Robotic surgical system allows for a minimally invasive, highly accurate approach to the disarticulation of
the costo-sternal joint and resection of the abnormal portion of the first rib. The result following robotic
first rib resection has been the best to date.

DECLARATIONS
Authors’ contributions
Collected the data, designed and performed the procedures, and composed the manuscript: Gharagozloo F,
Atiquzzaman N, Meyer M, Werden S

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.

REFERENCES
1. Stewman C, Vitanzo PC Jr, Harwood MI. Neurologic thoracic outlet syndrome: summarizing a complex history and evolution. Curr
Sports Med Rep 2014;13:100-6. DOI PubMed
2. Jones MR, Prabhakar A, Viswanath O, et al. Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and
treatment. Pain Ther 2019;8:5-18. DOI PubMed PMC
3. Gharagozloo F, Meyer M, Tempesta B, Strother E, Margolis M, Neville R. Proposed pathogenesis of Paget-Schroetter disease:
impingement of the subclavian vein by a congenitally malformed bony tubercle on the first rib. J Clin Pathol 2012;65:262-6. DOI
PubMed
4. Gharagozloo F, Atiquzzaman N, Meyer M, Tempesta B, Werden S. Robotic first rib resection for thoracic outlet syndrome. J Thorac
Dis 2020. DOI
5. Kobayashi S, Takeno K, Miyazaki T, et al. Effects of arterial ischemia and venous congestion on the lumbar nerve root in dogs. J
Orthop Res 2008;26:1533-40. DOI PubMed
6. Gharagozloo F, Meyer M, Tempesta B, Gruessner S. Robotic transthoracic first-rib resection for Paget-Schroetter syndrome. Eur J
Cardiothorac Surg 2019;55:434-9. DOI PubMed
7. Gharagozloo F, Meyer M, Tempest B, Weden S. Robotic first rib resection for thoracic outlet syndrome. Surg Technol Int
2020;36:239-44. PubMed
8. Gharagozloo F, Meyer M, Tempesta BJ, Margolis M, Strother ET, Tummala S. Robotic en bloc first-rib resection for Paget-Schroetter