Thoracic Outlet Syndrome: Single Center Experience on Robotic Assisted First Rib Resection and Literature Review

Abstract

BackgroundThoracic outlet syndrome (TOS) is a pathological condition caused by a narrowing between the clavicle and first rib leading to a compression of the neurovascular bundle to the upper extremity. The incidence of TOS is probably nowadays underestimated because the diagnosis could be very challenging without a thorough clinical examination along with appropriate clinical testing. Beside traditional supra-, infraclavicular or transaxillary approaches, the robotic assisted first rib resection has been gaining importance in the last few years.MethodsWe conducted a retrospective cohort analysis of all patients who underwent robotic assisted first rib resection due to TOS at Lucerne Cantonal Hospital and then we performed a narrative review of the English literature using PubMed, Cochrane Database of Systematic Reviews and Scopus.ResultsBetween June 2020 and November 2021, eleven robotic assisted first rib resections were performed due to TOS at Lucerne Cantonal Hospital. Median length of stay was 2 days (Standard Deviation: +/– 0.67 days). Median surgery time was 180 min (Standard Deviation: +/– 36.5). No intra-operative complications were reported.ConclusionsRobotic assisted first rib resection could represent a safe and feasible option in expert hands for the treatment of thoracic outlet syndrome.

Histologic evidence of brachial plexus compression sites at the thoracic inlet and variations in formation of the lower trunk in cadavers

“…Last, though our findings suggest that one-fifth to one-third of patients may have an anatomic variation predisposing them to neurologic TOS, previous studies have estimated the prevalence of neurologic TOS to range from 25 per year in a metropolitan area of 1,000,000 (Illig et al, 2021) to three to 80 in 1000 people for all forms of TOS (Gkikas et al, 2022). This syndrome is rarer than what our results suggest (Illig et al, 2021).…”

“…This syndrome is rarer than what our results suggest (Illig et al, 2021). Additionally, predisposing risk factors for TOS are known, as it affects young adults 20–50 years old and women 3–4 times more than men (Gkikas et al, 2022). The risk of TOS may be increased in those working occupations requiring prolonged elevation or repetitive use of the arms or with a history of trauma, masses, or other anatomical abnormalities in the thoracic inlet as well (Laulan et al, 2011).…”

Tackling complex thoracic surgical operations with robotic solutions: a narrative review

“…Notably, both procedures had no reported neurovascular complications, and patients had a median hospitalization stay of 3 days for nTOS and 4 days for vTOS procedures. Similarly, Gkikas et al discussed the safety of robotic first rib resection, comparing it with traditional techniques such as supraclavicular first rib resection, both intraoperatively and postoperatively ( 20 ). The study revealed that patients undergoing the robotic approach reported better pain control as measured by the visual analogue scale and morphine equivalents.…”

Uniportal robotic-assisted thoracoscopic surgery: resection of the first rib

“…Robotic-assisted thoracoscopic surgery (RATS) facilitates a rapid dissection of narrow spaces, with improved maneuverability and three-dimensional (3D) visualization, in contrast to conventional VATS. RATS was first performed with four ports ( 4 ), but gradually, improvements in robotic technique have reduced the number of ports required for resection of the first rib. However, this is the first case in the world in which surgical treatment of thoracic outlet syndrome has been carried out using a single port (or uniportal) RATS (uRATS).…”