INTRODUCTION Neurogenic thoracic outlet syndrome (TOS) is a musculoskeletal condition in which the brachial plexus is dynamically compressed within the scalene triangle, an anatomic space bordered by the anterior and middle scalene muscles and the first rib. In some cases, an offending cervical rib is present. Traditional surgical approaches to first rib resection and scalenectomy are limited by exposure, require retraction of neurovascular structures, and result in morbidity. METHODS We describe a novel transthoracic robotic approach to first/cervical rib resection that overcomes these limitations, and we review its early clinical outcomes. RESULTS Robotic first rib resection (FRR) is crystallized into 12 distinct steps, each with detailed video commentary, and nuances specific to neurogenic and venous TOS cases are provided. Published data supports decreased surgical morbidity of robotic FRR compared with open cases. CONCLUSIONS Robotic FRR offers advantages over traditional operative approaches including improved exposure and elimination of retraction of neurovascular structures, which result in improved safety.

中文翻译：

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经胸机器人第一和颈肋切除术治疗胸廓出口综合征。


简介 神经源性胸廓出口综合征 (TOS) 是一种肌肉骨骼疾病，其中臂丛神经在斜角肌三角内动态受压，斜角肌三角是一个由前、中斜角肌和第一肋骨界定的解剖空间。在某些情况下，存在有问题的颈肋。第一肋骨切除术和斜角肌切除术的传统手术方法受到暴露的限制，需要牵拉神经血管结构，并导致发病率。方法 我们描述了一种新颖的经胸机器人第一/颈肋骨切除方法，克服了这些局限性，并回顾了其早期临床结果。结果 机器人第一肋骨切除术 (FRR) 被具体化为 12 个不同的步骤，每个步骤都有详细的视频评论，并提供了神经源性和静脉性 TOS 病例特有的细微差别。已发表的数据支持与开放病例相比，机器人 FRR 的手术发病率降低。结论 机器人 FRR 比传统手术方法具有优势，包括改善暴露和消除神经血管结构的回缩，从而提高安全性。