title: Totally Endoscopic (VATS) First Rib Resection for Thoracic Outlet Syndrome.
abstract: BACKGROUND
  Thoracic outlet syndrome (TOS) causes neurologic symptoms in 95% of cases and vascular symptoms in 5% of cases. Surgical resection is curative. Endoscopic-assisted transaxillary first rib resection has been previously reported. In this study we report a totally endoscopic video-assisted thoracoscopic surgery (VATS) approach using tailored endoscopic instruments.
  
  
  METHODS
  Ten patients (8 women; average age, 32.3 ± 5.6 years) with TOS underwent VATS first rib resection following failure of symptom improvement with physiotherapy. Symptoms were: unilateral neurogenic (n = = 7), bilateral neurogenic (n = = 2), and bilateral arterial compression (n = = 1). Three standard VATS ports were utilized. The parietal pleura and periosteum overlying the first rib were stripped avoiding injury to the neurovascular bundle. The rib was transected with an endoscopic rib cutter and resected completely in a piecemeal fashion using endoscopic bone nibblers. All periosteal remnants were trimmed releasing the neurovascular bundle completely.
  
  
  RESULTS
  Patients were discharged within 72 hours following surgery. One patient had the contralateral side treated 18 months later and another patient is awaiting the second surgery. At follow-up, 9 patients had complete resolution of their main symptoms. One patient with neurogenic TOS developed mild functional and sensational loss of the non-dominant hand that improved within 8 months with physiotherapy.
  
  
  CONCLUSIONS
  VATS first rib resection for TOS provides, unlike the classic approaches, a superior, magnified, and well-illuminated view of the thoracic inlet. It allows good posterior trimming of the first rib, release of brachial plexus, and an aesthetically pleasing result, especially in female patients.
authors.affiliation: Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, United Kingdom.
authors.forename: Robert S
authors.initials: RS
authors.lastname: George
authors.affiliation: Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Milton
authors.affiliation: Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, United Kingdom.
authors.forename: Nilanjan
authors.initials: N
authors.lastname: Chaudhuri
authors.affiliation: Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, United Kingdom.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Kefaloyannis
authors.affiliation: Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, United Kingdom. Electronic address: k.papagiannopoulos@nhs.net.
authors.forename: Kostas
authors.initials: K
authors.lastname: Papagiannopoulos
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D013901:Thoracic Outlet Syndrome / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult