title: Robotic en bloc first-rib resection for Paget-Schroetter disease, a form of thoracic outlet syndrome: technique and initial results.
abstract: OBJECTIVE
  First-rib resection is a key component of the treatment of Paget-Schroetter disease. There are many controversies regarding the management of this disease. We report a safe, effective, minimally invasive robotic transthoracic approach for resection of the first rib.
  
  
  METHODS
  Over an 8-month period, five patients underwent robotic first-rib resection. Preoperative assessment included physical examination and bilateral venous angiography. On a thoracoscopic platform using three 2-cm incisions and one 1-cm incision, the robot was used to dissect the first rib and divide the scalene muscles. Success of the first-rib resection was assessed by postoperative venous angiography.
  
  
  RESULTS
  There were four men and one woman. Mean age was 34.6 ± 10 years. Mean operative time was 195 ± 24.6 minutes. There were no complications and no mortality. All patients had a patent subclavian vein on the postoperative venogram and were anticoagulated with warfarin for 3 months. At a median follow-up of 12 months, all patients had an open subclavian vein for a patency rate of 100%.
  
  
  CONCLUSIONS
  Robotic thoracoscopic first-rib resection represents a feasible minimally invasive approach to en bloc resection of the first rib. This technique minimizes the risk of neurovascular complications that are associated with conventional techniques.
authors.affiliation: Washington Institute of Thoracic and Cardiovascular Surgery, the George Washington University Medical Center, Washington, DC 20037, USA.
authors.forename: Farid
authors.initials: F
authors.lastname: Gharagozloo
authors.forename: Mark
authors.initials: M
authors.lastname: Meyer
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Tempesta
authors.forename: Marc
authors.initials: M
authors.lastname: Margolis
authors.forename: Eric T
authors.initials: ET
authors.lastname: Strother
authors.forename: Srini
authors.initials: S
authors.lastname: Tummala
mesh_terms: D000328:Adult; D000925:Anticoagulants; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D013901:Thoracic Outlet Syndrome / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000601:surgery*; D055815:Young Adult
chemical_list: D000925:Anticoagulants