Endoscopic transaxillary first rib resection for thoracic outlet syndrome: a safe surgical option.
BACKGROUND
Endoscopic-assisted transaxillary first rib resection is a novel approach in the management of thoracic outlet syndrome (TOS) and allows us to safely identify the neurovascular package and different structures. Our main objective is to assess the results of morbidity and mortality of the surgical treatment in TOS with this technique.


METHODS
We carried out a prospective, longitudinal study with 22 surgical interventions of transaxillary first rib resection with endoscopic support in patients with TOS from January 2000 to January 2009 in a private hospital located in Puebla, Mexico. There were 16 females and six males with a mean age of 35 years. We found 16/22 (72.7%) patients with neurological symptoms and 6/22 (27.3%) with venous symptoms; 2/22 (9.09%) patients had effort thrombosis of the axillary-subclavian vein.


RESULTS
Of the 22 interventions, we found fibrous bands in 8/22 patients (36.3%); 1/22 (4.5%) with type 1 cervical band and cervical rib grade II, 1/22 (4.5%) with type 2 cervical band and cervical rib grade I, 2/22 (9.09%) with band type 3, 1/22 (4.5%) with band type IV, 1/22 (4.5%) with band type V and 2/22 (9.09%) with band type VII and axillary-subclavian thrombosis. After the procedure, 20/22 (90.9%) patients showed total symptom improvement and 2/22 (9.1%) patients had mild paresthesias. There were no complications from nerve, vascular or pleural damage.


CONCLUSIONS
This technique provides an ample margin of safety and improves visibility, reducing surgical complications.
Departamento de Cirugía, Clínica Médica Quirúrgica Candia "Nuestra Señora de Lourdes," Puebla, Puebla, México. renef_candia@yahoo.com.mx
René Francisco
RF
Candia-de la Rosa
Arely
A
Pérez-Rodríguez
Raúl
R
Candia-García
Juan Miguel
JM
Palacios-Solís
D000293:Adolescent; D000328:Adult; D001132:Arm / Q000098:blood supply / Q000294:innervation; D001365:Axilla; D001367:Axillary Vein; D002573:Cervical Rib Syndrome / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D010292:Paresthesia / Q000209:etiology; D011446:Prospective Studies; D012272:Ribs / Q000601:surgery*; D013350:Subclavian Vein; D013901:Thoracic Outlet Syndrome / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology; D055815:Young Adult