World Journal of Surgery

, Volume 42, Issue 10, pp 3250–3255 | Cite as

First Rib Resection for Thoracic Outlet Syndrome: The Robotic Approach

  • Gregor J. KocherEmail author
  • Adrian Zehnder
  • Jon A. Lutz
  • Juerg Schmidli
  • Ralph A. Schmid
Original Scientific Report with Video



First rib resection is a well-recognized treatment option for thoracic outlet syndrome (TOS). In case of a vascular insufficiency that can be provoked and/or progressive neurologic symptoms without response to conservative treatment, surgical decompression of the space between the clavicle and the first rib is indicated. The aim of this paper is to present our experience with a new minimally invasive robotic approach using the da Vinci Surgical System®.


Between January 2015 and October 2017, eight consecutive first rib resections in seven patients were performed at our institution. Four patients presented with neurologic (one bilateral), and three patients with vascular (venous) impairment. In all cases, a transthoracic robotic-assisted approach was used. The first rib was removed using a 3-port robotic approach with an additional 2-cm axillary incision in the first six patients. The latest resection was performed through only three thoracic ports.


Median operative time was 108 min, and the median hospital stay was 2 days. Postoperative courses were uneventful in all patients. Clinical follow-up examinations showed relief of symptoms in all nonspecific TOS patients, and duplex ultrasonography confirmed complete vein patency in the remaining patients 3 months after surgery.


While there are limitations in conventional transaxillary, subclavicular and supraclavicular approaches in the first rib resection, the robotic method is not only less invasive but also allows better exposure and visualization of the first rib. Furthermore, the technique takes advantage of the benefits of the da Vinci Surgical System® in terms of 3D visualization and improved instrument maneuverability. Our early experience clearly demonstrates these advantages, which are also supported by the very good outcomes.


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

Supplementary material 1 (MP4 158063 kb)


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Gregor J. Kocher
    • 1
    Email author
  • Adrian Zehnder
    • 1
  • Jon A. Lutz
    • 1
  • Juerg Schmidli
    • 2
  • Ralph A. Schmid
    • 1
  1. 1.Division of General Thoracic Surgery, Bern University HospitalUniversity of BernBernSwitzerland
  2. 2.Division of Cardiovascular Surgery, Bern University HospitalUniversity of BernBernSwitzerland

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