title: A video-assisted thoracoscopic approach to transaxillary first rib resection.
abstract: OBJECTIVE
  Thoracic outlet syndrome (TOS) can be associated with neurologic, arterial, or venous deficiencies. When nonsurgical treatment has failed to adequately palliate TOS, surgical intervention is indicated. The supraclavicular and transaxillary approaches are currently the most commonly used approaches for first rib resection, yet little has been reported to date on outcomes of minimally invasive procedures, such as video-assisted thoracoscopic surgery (VATS). The purpose of this article was to describe a minimally invasive approach to TOS and the associated outcomes.
  
  
  METHODS
  This study is a retrospective analysis of a prospectively maintained database. Patients who failed nonsurgical therapy for TOS were referred to our practice for evaluation of surgery with a VATS minimally invasive first rib resection. Between 2001 and 2010, 66 VATS procedures were performed on 58 patients (41 women, 17 men). Patients were followed postoperatively for a mean time of 13.5 months.
  
  
  RESULTS
  Forty-one patients were women (70.7%), and the mean age was 40.5 years, with a patient age range of 17 to 59 years. The mean length of hospital stay was 2.47 days; median length of stay was 2 days. There were a total of eight complications (12.1%). There were no mortalities.
  
  
  CONCLUSIONS
  Video-assisted thoracoscopic surgery first rib resection for TOS is another feasible option for TOS, which can be added to the armamentarium of the thoracic surgeon. The outcomes associated with our technique are comparable with the outcomes related to other current standards of care.
authors: From the Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors: Harmik J
authors: HJ
authors: Soukiasian
authors: Daniel
authors: D
authors: Shouhed
authors: Derek
authors: D
authors: Serna-Gallgos
authors: Robert
authors: R
authors: McKenna
authors: Vahak J
authors: VJ
authors: Bairamian
authors: Robert J
authors: RJ
authors: McKenna
mesh_terms: D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D013901:Thoracic Outlet Syndrome / Q000473:pathology / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult