Endoscopic Assisted Transaxially Approach for First Rib Resection in Thoracic Outlet Syndromes

Thoracic outlet syndrome (TOS) is a complex of signs and symptoms resulting from compression the nerves vessels supplying upper limb. Previous articles described that physicians who do not regularly treat patients with TOS may have an accurate view this disorder, its treatment, or possible success rate treatment. Roos reported underdiagnosed. Difficulty in diagnosis correctly cause unexplained various less objective diagnostic criteria. Moreover, surgical management for remains more challenging. Transaxillary first rib resection well-established treatment symptomatic TOS. However, it does allow adequate exposure insertion scalene muscle to rib. Because surgery involves many intimately related structures, theoretical complications are numerous be severe. There were including brachial plexus dysfunction fatal subclavian artery vein injury. Recent showed help endoscope, safety invasive has been achieved. The purpose study access feasibility endoscopic assisted transaxially approach Forty-eight cases (21 women 27 men; mean age, 28.1 years; range, 13-57 years) underwent partial reviewed retrospectively. Conventional by was before identification A 4.0 mm 30°arthroscope introduced additional small port placed anterior latissimus dorsi. scope allowed visual confirmation contents thoracic outlet. Endoscopic classification neurovascular bundle patterns (NVB), is, alignment nerve, artery, evaluated intraoperatively. In addition, distance between middle at edge clavicle measured. transected anteriorly near costochondral junction posteriorly as close transverse process piece fashion under good visualization great care avoid injury immediately muscles. Wood score DASH obtained postoperatively. Intraoperative findings revealed 3 classifications NVB based on muscles, artery: parallel type (9 cases) which nerve travel parallelly; oblique (24 cases), behind artery; vertical (15 totally abnormal band. Abnormal 15 type) found 39 (81.3%). patients, interscalene narrow (4.9 mm, range 0-13 mm). Of congenital fibrous bands identified, 26 31 selectively compressing lower trunk plexus. exceeded tubercle extended onto superior surface 13 through interval. Postoperative clinical excellent results 38 (79.2%) fair poor recorded 10 (20.8%). Pre- postoperative scores were, 35.1 (range 2-77) 19 (0-72), respectively. No major complication except one pneumothorax. Although transaxillary TOS, procedure requires meticulous technique special attention fine details achieve best least complications. Therefore, hesitate diagnose