Abstract
Objectives
Robotic first rib resection (R-FRR) is an emerging approach in the field of thoracic
outlet syndrome (TOS) that has technical advantages over traditional open approaches,
including superior exposure of the first rib and freedom from retracting neurovascular
structures. We set out to define the safety of R-FRR and compare it with that of the
conventional supraclavicular approach (SC-FRR).
Methods
We queried a prospectively maintained, single-surgeon, single-institution database
for all FRR operations performed for neurogenic TOS and venous TOS. Preoperative,
intraoperative, and complications were compared between approaches.
Results
Seventy-two R-FRRs and 51 SC-FRRs were performed in 66 and 50 patients, respectively.
These groups were not significantly different in age, body mass index, sex, type of
TOS, or preoperative use of opioids. Length of procedure and hospital stay were not
different between groups. Postoperative inpatient self-reported pain (visual analog
scale score 4.7 vs 5.2; P = .049) and administered morphine milligram equivalents (37.5 vs 81.1 MME, P < .001) were significantly lower in R-FRR than SC-FRR. Brachial plexus palsy was
less frequent after R-FRR than SC-FRR (1% vs 18%, P = .002) and resolved by 4 months in call cases. All cases were sensory palsies with
the exception of 2 motor palsies, which were both in the SC-FRR group. In multivariable
analyses, R-FRR was independently associated with less frequent total complications
than SC-FRR (P = .002; odds ratio, 0.08; 95% confidence interval, 0.02-0.39).
Conclusions
R-FRR provides outstanding exposure of the first rib and eliminates retraction of
the brachial plexus and its consequences.
Key Words
Abbreviations and Acronyms:
FRR (first rib resection), ICS (intercostal space), MME (morphine milligram equivalent), PCA (patient-controlled analgesia), PT (physical therapy), nTOS (neurogenic thoracic outlet syndrome), R-FRR (robotic transthoracic first rib resection), SC-FRR (supraclavicular first rib resection), TOS (thoracic outlet syndrome), VAS (visual analog scale), vTOS (venous thoracic outlet syndrome)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 03, 2020
Accepted:
August 23,
2020
Received in revised form:
August 10,
2020
Received:
June 21,
2020
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
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