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Belyak EA, Lazko FL, Sufianov AA, Paskhin DL, Prizov AP, Lazko MF, Sagdiev RK, Zagorodniy NVE. Extra-Articular Endoscopic BP Decompression-Surgical Technique. Arthrosc Tech 2024; 13:102938. [PMID: 38835473 PMCID: PMC11144805 DOI: 10.1016/j.eats.2024.102938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/31/2023] [Indexed: 06/06/2024] Open
Abstract
We describe all-endoscopic brachial plexus (BP) decompression. Surgery is performed with the patient in the beach-chair position with the usual arthroscopic instruments and pump. The first step is to create 2 portals at the area of the coracoid process and decompress the infraclavicular part of the BP at area of thoracic aperture and coracoid. The second step includes performing 2 portals at supraclavicular fossa and performing decompression of BP at interscalene space. The postoperative period includes a short period of sling immobilization (3-5 days), immediate passive motion after surgery, and active motion after removal of the sling.
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Affiliation(s)
- Evgeniy Aleksandrovich Belyak
- Moscow state city hospital in honor of Buyanov V.M., Docent of Peoples' Friendship University of Russia (RUDN University) Moscow, Russia, Moscow, Russia
| | - Fjodor Leonidovich Lazko
- Moscow state city hospital in honor of Buyanov V.M., Docent of Peoples' Friendship University of Russia (RUDN University) Moscow, Russia, Moscow, Russia
| | - Albert Akramovich Sufianov
- Department of Neurosurgery, I.M. Sechenov First State Medical University (Sechenov University), Moscow, Russia
- Educational and Scientific Institute of Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
- Federal Centre of Neurosurgery, Moscow, Russia
| | - Dmitriy Lvovich Paskhin
- Moscow state city hospital in honor of Buyanov V.M., Docent of Peoples' Friendship University of Russia (RUDN University) Moscow, Russia, Moscow, Russia
| | - Alexey Petrovich Prizov
- Moscow state city hospital in honor of Buyanov V.M., Docent of Peoples' Friendship University of Russia (RUDN University) Moscow, Russia, Moscow, Russia
| | - Maxim Fjodorovich Lazko
- Moscow state city hospital in honor of Buyanov V.M., Docent of Peoples' Friendship University of Russia (RUDN University) Moscow, Russia, Moscow, Russia
| | - Ranel Khamitovich Sagdiev
- Department of Neurosurgery, I.M. Sechenov First State Medical University (Sechenov University), Moscow, Russia
| | - Nikolay Vasil Evich Zagorodniy
- Educational and Scientific Institute of Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
- Orthopedic Department of Federal State Budgetary Institution of the Ministry of Health of the Russian Federation National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov, Moscow, Russia
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Mulatti GC, Dalio MB, de Moraes TM, Attie GA, Brito-Queiroz A, Joviliano EE. Thoracic outlet syndrome in women. Semin Vasc Surg 2024; 37:44-49. [PMID: 38704183 DOI: 10.1053/j.semvascsurg.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 05/06/2024]
Abstract
Thoracic outlet syndrome (TOS) is observed more frequently in women, although the exact causes of this sex disparity remain unclear. By investigating the three types of TOS-arterial, neurogenic, and venous-regarding symptoms, diagnosis, and treatment, this article aims to shed light on the current understanding of TOS, focusing on its variations in women.
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Affiliation(s)
- Grace Carvajal Mulatti
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, R. Dr. Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP, 05403-010, Brasil.
| | - Marcelo Bellini Dalio
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Tayrine Mazotti de Moraes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, R. Dr. Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP, 05403-010, Brasil
| | - Gabriela Araújo Attie
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, R. Dr. Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP, 05403-010, Brasil
| | | | - Edwaldo Edner Joviliano
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
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Sutton W, O'Neill J, Strother E, Grossman DA, Hwalek AE, Margolis M. Video-assisted thoracic surgery and robotic-assisted first-rib excision and thoracic outlet syndrome decompression. Semin Vasc Surg 2024; 37:82-89. [PMID: 38704188 DOI: 10.1053/j.semvascsurg.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 05/06/2024]
Abstract
Multiple surgical approaches have been used in the management of thoracic outlet syndrome. These approaches have traditionally been "open" approaches and have been associated with the inherent morbidities of an open approach, including a risk of injury to the neurovascular structures due to traction and trauma while resecting the first rib. In addition, there has been concern that recurrence of symptoms may be related to incomplete resection of the rib with conventional open techniques. With the advent of minimally invasive thoracic surgery, surgeons began to explore first-rib resection via a thoracoscopic approach. Unfortunately, the existing video-assisted thoracic surgery technology and equipment was not well suited to working in the apex of the chest. With the introduction and subsequent progress in robotic surgery and instrumentation, this dissection can be performed with all the advantages of robotics, but also with minimal traction and trauma to the neurovascular structures, and incorporates almost complete resection of the rib with minimal residual stump. Robotics has developed as a reliable, safe, and less invasive approach to first-rib resection, yielding excellent results while limiting the morbidity of the procedure.
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Affiliation(s)
- Whitney Sutton
- Department of Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, 20007.
| | - John O'Neill
- Department of Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, 20007
| | - Eric Strother
- Department of Cardiothoracic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Danielle A Grossman
- Department of Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, 20007
| | - Ann E Hwalek
- Department of Cardiothoracic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Marc Margolis
- Department of Cardiothoracic Surgery, MedStar Georgetown University Hospital, Washington, DC
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Egyud MR, Burt BM. Robotic First Rib Resection and Robotic Chest Wall Resection. Thorac Surg Clin 2023; 33:71-79. [DOI: 10.1016/j.thorsurg.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Liu B, Gao S, Wu Q, Li H, Zhang G, Fu J. A case report of robotic-assisted resection of large fibrous benign tumor of second rib. J Cardiothorac Surg 2022; 17:329. [PMID: 36539826 PMCID: PMC9769036 DOI: 10.1186/s13019-022-02041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Surgical resection is the most effective curative management of benign rib tumors and carries an excellent prognosis. Due to complex anatomy and narrow field, higher rib resection is technically demanding and requires extensive dissection. CASE PRESENTATION We report a case of second rib tumor resection performed transthoracic under Da Vinci robot assistance. A 32-year-old male complained about increasing pain in the left anterior chest wall. After 3D reconstruction of CT, it showed a well-circumscribed fusiform lesion with a multi-component structure. Measured 17 × 6 × 4 cm and extended into the chest cavity to the depth below the pectoralis minor muscle. The patient underwent robotic-assisted trans-thoracic second rib resection. At four weeks of outpatient follow-up, the patient reported no pain and uncomplicated wound healing. CONCLUSION This minimally invasive approach offers optimal visualization and tissue manipulation while dramatically decreasing the possibility of collateral damage, hence ensuring fast function recovery. To the best of our knowledge, these kinds of procedures are rarely reported in detail.
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Affiliation(s)
- Bohao Liu
- grid.452438.c0000 0004 1760 8119Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, 277# Yanta West Road, Xi’an, 710061 Shaanxi China
| | - Shan Gao
- grid.452438.c0000 0004 1760 8119Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, 277# Yanta West Road, Xi’an, 710061 Shaanxi China
| | - Qifei Wu
- grid.452438.c0000 0004 1760 8119Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, 277# Yanta West Road, Xi’an, 710061 Shaanxi China
| | - Haijun Li
- grid.452438.c0000 0004 1760 8119Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, 277# Yanta West Road, Xi’an, 710061 Shaanxi China
| | - Guangjian Zhang
- grid.452438.c0000 0004 1760 8119Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, 277# Yanta West Road, Xi’an, 710061 Shaanxi China
| | - Junke Fu
- grid.452438.c0000 0004 1760 8119Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, 277# Yanta West Road, Xi’an, 710061 Shaanxi China
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Davidovic LB, Zlatanovic P, Dragas M, Koncar I, Micic M, Matejevic D. Arterial thoracic outlet syndrome: a 30-year experience in a high-volume referral center. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:687-694. [PMID: 36106396 DOI: 10.23736/s0021-9509.22.12224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The purpose of this study was to assess the clinical presentation and contemporary management of arterial thoracic outlet syndrome (TOS) in high-volume referral center. METHODS We conducted a retrospective review of a prospectively maintained database of patients with TOS of any etiology between January 1st 1990 and 2021. Supra-, or combined supra-/infraclavicular approaches have been used for decompression/vascular reconstructions. The group was divided into two equal time periods: period 1 (1990-2006, N.=27) and period 2 (2006-2021, N.=36). RESULTS Sixty-three consecutive patients underwent surgical treatment due to arterial TOS. Period 2 had more patients who were asymptomatic (N.=16, 44.4% vs. N.=0, 0%, P<0.001) and those presenting with critical hand ischemia (N.=12, 33.3% vs. N.=0, 0%, P=0.01), while acute limb ischemia was more common in period 1 (N.=16, 59.2% vs. N.=5, 13.9%, P<0.001). SA compression without lesion was more common in period 2 (N.=16, 44.4% vs. N.=0, 0%, P<0.001), while SA intimal damage with mural thrombus formation was more common in the period 1 (N.=12, 44.4% vs. N.=1, 2.7%, P<0.001). Decompression as an isolated procedure was performed in 25.4% (N.=16) of all asymptomatic patients, while combined decompressive and vascular procedure in 71.4% (N.=45) of patients. The most common postoperative complication was pneumothorax (N.=7, 11.1%). CONCLUSIONS The supraclavicular approach with its modifications provides adequate decompression and allows also repair or reconstruction of the SA, as well as complete additional revascularization of the upper extremity without the need for further patient repositioning. While treatment methods and early outcomes have not changed significantly over time, there has been a trend towards different clinical and SA pathomorphological presentation.
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Affiliation(s)
- Lazar B Davidovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Petar Zlatanovic
- Clinic for Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, Serbia -
| | - Marko Dragas
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Igor Koncar
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Mihajlo Micic
- Clinic for Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - David Matejevic
- Clinic for Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
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Panther EJ, Reintgen CD, Cueto RJ, Hao KA, Chim H, King JJ. Thoracic outlet syndrome: a review. J Shoulder Elbow Surg 2022; 31:e545-e561. [PMID: 35963513 DOI: 10.1016/j.jse.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/06/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023]
Abstract
Thoracic outlet syndrome (TOS) is a rare condition (1-3 per 100,000) caused by neurovascular compression at the thoracic outlet and presents with arm pain and swelling, arm fatigue, paresthesias, weakness, and discoloration of the hand. TOS can be classified as neurogenic, arterial, or venous based on the compressed structure(s). Patients develop TOS secondary to congenital abnormalities such as cervical ribs or fibrous bands originating from a cervical rib leading to an objectively verifiable form of TOS. However, the diagnosis of TOS is often made in the presence of symptoms with physical examination findings (disputed TOS). TOS is not a diagnosis of exclusion, and there should be evidence for a physical anomaly that can be corrected. In patients with an identifiable narrowing of the thoracic outlet and/or symptoms with a high probability of thoracic outlet neurovascular compression, diagnosis of TOS can be established through history, a physical examination maneuvers, and imaging. Neck trauma or repeated work stress can cause scalene muscle scaring or dislodging of a congenital cervical rib that can compress the brachial plexus. Nonsurgical treatment includes anti-inflammatory medication, weight loss, physical therapy/strengthening exercises, and botulinum toxin injections. The most common surgical treatments include brachial plexus decompression, neurolysis, and scalenotomy with or without first rib resection. Patients undergoing surgical treatment for TOS should be seen postoperatively to begin passive/assisted mobilization of the shoulder. By 8 weeks postoperatively, patients can begin resistance strength training. Surgical treatment complications include injury to the subclavian vessels potentially leading to exsanguination and death, brachial plexus injury, hemothorax, and pneumothorax. In this review, we outline the diagnostic tests and treatment options for TOS to better guide clinicians in recognizing and treating vascular TOS and objectively verifiable forms of neurogenic TOS.
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Affiliation(s)
- Eric J Panther
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christian D Reintgen
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Robert J Cueto
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Harvey Chim
- Department of Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA.
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A clinical case of a combined endoscopic treatment: brachial plexus decompression in the thoracic aperture and subacromial spacer implantation. КЛИНИЧЕСКАЯ ПРАКТИКА 2022. [DOI: 10.17816/clinpract109942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Thoracic outlet syndrome compression of the brachial plexus in the area between the clavicle and the first rib is a commonly spread and important pathology. It occurs, as usual, after a trauma or due to an anatomical malformation of this area. Thoracic outlet syndrome can be combined with a shoulder joint pathology. In the case of a conservative treatment's failure, the standard surgical procedure is decompression of the brachial plexus in the thoracic aperture. This procedure is usually done via an open approach. The development of the endoscopic surgical technique of decompression allows reducing the risk of complications and recurrences, improving the cosmetic result and relieving the rehabilitation period. Clinical case description: A 73-year-old female patient with a clinical picture of posttraumatic brachial plexopathy and a massive shoulder rotator cuff tear. The patient underwent a conservative treatment for 6 months after the trauma without a significant improvement. To confirm the diagnosis, ENMG and an ultrasound investigation of the brachial plexus, as well as MRI of the shoulder joint were performed. Simultaneous shoulder joint arthroscopy with subacromial spacer implantation and brachial plexus decompression in the thoracic aperture were performed to the patient. According to the VAS-scale (Visual Analogue Scale), the severity of pain syndrome before the surgery was 10 cm, while 6 months after the surgery, it decreased to 1 cm. According to the DASH scale (Disabilities of the Arm, Shoulder, and Hand), the dysfunction of the of shoulder joint before the surgery was 76 points, while 6 months after the surgery, it decreased to 12 points. The range of motion in the shoulder joint before the surgery was as follows: flexion 105, abduction 95, external rotation 15, which increased to 160, 165, and 45, respectively, 6 months after the surgery. Conclusion: The results allow us to characterize the method of simultaneous shoulder joint arthroscopy and endoscopic decompression of the brachial plexus in the thoracic aperture as a low-traumatic and effective technique. The technique provides complete brachial plexus decompression in the thoracic aperture which promotes restoration of the function of the upper extremity and shoulder joint, and elimination of pain syndrome from the upper extremity area.
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Satake H, Honma R, Nito T, Naganuma Y, Shibuya J, Maruyama M, Uno T, Takagi M. Midterm results of endoscopically assisted first rib resection in the zero position for thoracic outlet syndrome. Interact Cardiovasc Thorac Surg 2022; 35:6696242. [PMID: 36094365 PMCID: PMC9536291 DOI: 10.1093/icvts/ivac239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Hiroshi Satake
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Ryusuke Honma
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Toshiya Nito
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Yasushi Naganuma
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Junichiro Shibuya
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Masahiro Maruyama
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Tomohiro Uno
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
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Goeteyn J, Pesser N, Houterman S, van Sambeek MR, van Nuenen BF, Teijink JA. Surgery versus continued conservative treatment for neurogenic thoracic outlet syndrome: the first randomised clinical trial (STOPNTOS-trial). Eur J Vasc Endovasc Surg 2022; 64:119-127. [DOI: 10.1016/j.ejvs.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022]
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Ammi M, Hersant J, Henni S, Daligault M, Papon X, Abraham P, Picquet J. Evaluation Of Quality Of Life After Surgical Treatment Of Thoracic Outlet Syndrome. Ann Vasc Surg 2022; 85:276-283. [PMID: 35339598 DOI: 10.1016/j.avsg.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND To evaluate the quality of life of surgically treated patients for TOS. METHODS A prospective observational study including patients treated surgically for TOS, on 2018. Two standardized questionnaires: Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Short-Form 12 (SF-12) were used. The SF-12 consists of a physical and mental component (PCS-SF-12 and MCS-SF-12). The questionnaires were completed during the preoperative and postoperative consultations and at 3, 6, and 12 months. RESULTS We performed 53 interventions. The population was mostly female (n = 35, 66.0%) of 40.1±10.0 years. The preoperative DASH score was 46.3±19.7. It was 40.9±21.7 at 6 weeks, 33.5±22.7 at 3 months, 28.9±22.6 at 6 months, and 21.1±20 at 9 to 12 months. The improvement of DASH becomes statistically significant at 3 months (p = 0.036), 6 months (p = 0.002), and 12 months (p = 0.001). The preoperative MCS-SF-12 was 36.6±9.4. It was 41.6±10.9 at 6 weeks, 43.8±11.1 at 3 months, 46.2±11.8 at 6 months, and 51.4±8 at 8 to 12 months. The improvement of MCS-SF-12 became significant at 3 months (p=0.009), 6 months (p=0.001), and 12 months (p=0.001). The preoperative PCS-SF-12 was 35.5±6.4. It was 37.1±8.7 at 6 weeks, 39.9±8.7 at 3 months, 41.6±8.4 at 6 months, and 46.1±8.1 to 12 months. The improvement of PCS-SF-12 became significant at 6 months (p=0.005) and 12 months (p=0.001). CONCLUSION The surgical management of TOS allows an improvement of quality of life in short and medium term.
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Affiliation(s)
- Myriam Ammi
- Department of Vascular and Thoracic Surgery, University Hospital, 49933 Angers, France.
| | - Jeanne Hersant
- Department of Vascular and Sport Investigations, University Hospital, 49933 Angers, France
| | - Samir Henni
- Department of Vascular and Thoracic Surgery, University Hospital, 49933 Angers, France
| | - Mickael Daligault
- Department of Vascular and Thoracic Surgery, University Hospital, 49933 Angers, France
| | - Xavier Papon
- Department of Vascular and Thoracic Surgery, University Hospital, 49933 Angers, France
| | - Pierre Abraham
- Department of Vascular and Sport Investigations, University Hospital, 49933 Angers, France
| | - Jean Picquet
- Department of Vascular and Thoracic Surgery, University Hospital, 49933 Angers, France
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Gkikas A, Lampridis S, Patrini D, Kestenholz PB, Azenha LF, Kocher GJ, Scarci M, Minervini F. Thoracic Outlet Syndrome: Single Center Experience on Robotic Assisted First Rib Resection and Literature Review. Front Surg 2022; 9:848972. [PMID: 35350142 PMCID: PMC8957785 DOI: 10.3389/fsurg.2022.848972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Andreas Gkikas
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, United Kingdom
| | - Savvas Lampridis
- Department of Thoracic Surgery, 424 General Military Hospital, Thessaloniki, Greece
| | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals, London, United Kingdom
| | - Peter B. Kestenholz
- Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Luis Filipe Azenha
- Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Gregor Jan Kocher
- Division of Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Scarci
- Department of Thoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Fabrizio Minervini
- Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
- *Correspondence: Fabrizio Minervini
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Nuutinen H, Kärkkäinen JM, Kimmo M, Voitto A, Teemu R, Petri S, Janne P. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6545787. [PMID: 35262705 PMCID: PMC9252101 DOI: 10.1093/icvts/ivac040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/20/2022] [Accepted: 02/02/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Henrik Nuutinen
- Department of Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
- Corresponding author. Henrik Nuutinen, Kuopio University Hospital, Department of Surgery. PL 100, 70029 Kuopio, Finland. e-mail:
| | | | - Mäkinen Kimmo
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Aittola Voitto
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Saari Petri
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Pesonen Janne
- Department of Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland
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14
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Li Y, Liu Y, Zhang Z, Gao X, Cui S. A Novel Approach to First-Rib Resection in Neurogenic Thoracic Outlet Syndrome. Front Surg 2021; 8:775403. [PMID: 34869570 PMCID: PMC8632710 DOI: 10.3389/fsurg.2021.775403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/26/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives: The treatment for neurogenic thoracic outlet syndrome (NTOS) conventionally involves first-rib resection (FRR) surgery, which is quite challenging to perform, especially for novices, and is often associated with postoperative complications. Herein, we report a new segmental resection approach through piezo surgery that involves using a bone cutter, which can uniquely provide a soft tissue protective effect. Methods: This retrospective study involved the examination of 26 NTOS patients who underwent piezo surgery and another group of 30 patients who underwent FRR using the conventional technique. In the patient group that underwent piezo surgery, the rib was first resected into two pieces using a piezoelectric device and subsequently removed. In the patient group that underwent conventional surgery, the first rib was removed as one piece using a rib cutter and rongeurs. Results: The piezo surgery group had significantly shorter operative time (96.85 ± 14.66 vs. 143.33 ± 25.64 min, P < 0.001) and FRR duration (8.73 ± 2.11 vs. 22.23 ± 6.27 min, P < 0.001) than the conventional group. The posterior stump length of the residual rib was shorter in the piezo surgery group than in the conventional group (0.54 ± 0.19 vs. 0.65 ± 0.15 cm, P < 0.05). There were no significant differences in postoperative complications and scores of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Cervical Brachial Symptom Questionnaire (CBSQ), and the visual analog scale (VAS). Even the TOS index (NTOS Index = [DASH + (0.83 × CBSQ) + (10 × VAS)]/3) and patient self-assessments of both the groups showed no significant differences. Univariate analyses indicated that the type of treatment affected operative time. Conclusion: Our results suggest that piezo surgery is safe, effective, and simple for segmental FRR in NTOS patients. Piezo surgery provides a more thorough FRR without damaging adjacent soft tissues in a relatively short duration and achieves similar functional recovery as conventional techniques. Therefore, piezo surgery can be a promising alternative for FRR during the surgical treatment of NTOS.
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Affiliation(s)
- Yueying Li
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yanxi Liu
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhan Zhang
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xuehai Gao
- Department of Nursing, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shusen Cui
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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Gharagozloo F, Atiquzzaman N, Meyer M, Tempesta B, Werden S. Robotic first rib resection for thoracic outlet syndrome. J Thorac Dis 2021; 13:6141-6154. [PMID: 34795965 PMCID: PMC8575845 DOI: 10.21037/jtd-2019-rts-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/07/2020] [Indexed: 11/18/2022]
Abstract
Robotic resection of the “offending portion” of the first rib in patients with thoracic outlet syndrome (TOS) has been associated with excellent results. The results have been due to (I) a better understanding of the pathogenesis of TOS, and (II) the technical advantages of the robotic platform. This article outlines the recent understanding of the pathogenesis of TOS, and reports the experience with robotic resection of the “offending portion” of the first rib in patients with neurogenic and venous TOS. Patients diagnosed with TOS underwent robotic first rib resection. Diagnosis of TOS was made by magnetic resonance angiography (MRA). On a thoracoscopic platform, the robot was used to dissect the “offending portion” of the first rib. A total of 162 patients underwent robotic first rib resection. Eighty-three patients underwent robotic first rib resection for Paget-Schroetter syndrome (PSS) (venous TOS). There were 49 men and 34 women. Mean age was 24±8.5 years. Operative time was 127.6±20.8 minutes. Median hospitalization was 4 days. There were no surgical complications, neurovascular injuries, or mortality. At a median follow-up of 24 months, all patients had an open subclavian vein (SV) for a patency rate of 100%. Seventy-nine patients underwent robotic first rib resection for neurologic symptoms of the upper extremity (neurogenic TOS). There were 29 men and 50 women. Mean age was 34±9.5 years. Operative time was 87.6±10.8 minutes. There were no intraoperative complications. Hospital stay ranged from 2–4 days with a median hospitalization of 3 days. There were no neurovascular complications. There was no mortality. In patients with neurogenic symptoms, Quick DASH Scores (mean ± SEM) decreased from 60.3±2.1 preoperatively to 5±2.3 in the immediate postoperative period, and 3.5±1.1 at 6 months (P<0.0001). Immediate relief of symptoms was seen in 71/79 (91%) patients. Persistent paresthesia was seen in 9/79 (9%) immediately postop and 3/79 (3.8%) patients at 6 months. Following the appropriate identification of the “offending portion” of the first rib which results in compression of the SV at its junction with the innominate vein by MRA, robotic resection of the “offending portion” of the first rib allows is associated with excellent results.
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Affiliation(s)
- Farid Gharagozloo
- Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health Celebration, University of Central Florida, Celebration, FL, USA
| | - Nabhan Atiquzzaman
- Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health Celebration, University of Central Florida, Celebration, FL, USA
| | - Mark Meyer
- Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health Celebration, University of Central Florida, Celebration, FL, USA
| | - Barbara Tempesta
- Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health Celebration, University of Central Florida, Celebration, FL, USA
| | - Scott Werden
- Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health Celebration, University of Central Florida, Celebration, FL, USA
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Completely thoracoscopic 3-port robotic first rib resection for thoracic outlet syndrome. Ann Thorac Surg 2021; 114:1238-1244. [PMID: 34592270 DOI: 10.1016/j.athoracsur.2021.08.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/03/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND In thoracic outlet syndrome (TOS), the constriction between bony and muscular structures leads to compression of the neurovascular bundle to the upper extremity. Traditional surgical techniques using supra-, infraclavicular or transaxillary approaches to remove the first rib do not usually allow good exposure of the entire rib and neurovascular bundle. We have therefore developed a robotic approach to overcome these limitations. METHODS Between January 2015 and November 2020, 38 consecutive first rib resections for neurogenic, venous or arterial TOS were performed in 34 patients at our institutions. For our completely portal approach, we used two 8mm working ports and one 12mm camera port. RESULTS The surgery time was between 71 to 270 min (median 133 min, SD+/-44.7 min) without any complications. Chest tube was removed on postoperative day 1 in all patients and the hospital stay after surgery ranged from 1 to 7 days (median 2 days, SD+/-2.1 days). No relevant intra- or postoperative complications were observed and complete or subtotal resolution of symptoms was seen in all patients. CONCLUSIONS The robotic technique described here for first rib resection has proven to be a safe and effective approach. The unsurpassed exposure of the entire first rib and possibility for a robotic-assisted meticulous surgical dissection has prevented both intra- and postoperative complications. This makes this technique unique as the safest and most minimally invasive approach to date. It helps improving patient outcomes by reducing perioperative morbidity with an easily adoptable procedure.
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Guadarrama-Ortíz P, Montes de Oca-Vargas I, Garibay-Gracián A, Choreño-Parra JA, Ruíz-Rivero CO, Capi-Casillas D, Alpízar-Acevedo AS, Prieto-Rivera ÁD. A modified supraclavicular approach to scalenotomy without first rib resection for the treatment of neurogenic thoracic outlet syndrome. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Zehnder A, Lutz J, Dorn P, Minervini F, Kestenholz P, Gelpke H, Schmid RA, Kocher GJ. Robotic-Assisted Thoracoscopic Resection of the First Rib for Vascular Thoracic Outlet Syndrome: The New Gold Standard of Treatment? J Clin Med 2021; 10:3952. [PMID: 34501401 PMCID: PMC8432239 DOI: 10.3390/jcm10173952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
In thoracic outlet syndrome (TOS) the narrowing between bony and muscular structures in the region of the thoracic outlet/inlet results in compression of the neurovascular bundle to the upper extremity. Venous compression, resulting in TOS (vTOS) is much more common than a stenosis of the subclavian artery (aTOS) with or without an aneurysm. Traditional open surgical approaches to remove the first rib usually lack good exposure of the entire rib and the neurovascular bundle. Between January 2015 and July 2021, 24 consecutive first rib resections for venous or arterial TOS were performed in 23 patients at our institutions. For our completely portal approach we used two 8mm working ports and one 12/8 mm camera port. Preoperatively, pressurized catheter-based thrombolysis (AngioJet®) was successfully performed in 13 patients with vTOS. Operative time ranged from 71-270 min (median 128.5 min, SD +/- 43.2 min) with no related complications. The chest tube was removed on Day 1 in all patients and the hospital stay after surgery ranged from 1 to 7 days (median 2 days, SD +/- 2.1 days). Stent grafting was performed 5-35 days (mean 14.8 days, SD +/- 11.1) postoperatively in 6 patients. The robotic approach to first rib resection described here allows perfect exposure of the entire rib as well as the neurovascular bundle and is one of the least invasive surgical approaches to date. It helps improve patient outcomes by reducing perioperative morbidity and is a procedure that can be easily adopted by trained robotic thoracic surgeons. In particular, patients with a/vTOS may benefit from careful and meticulous preparation and removal of scar tissue around the vessels.
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Affiliation(s)
- Adrian Zehnder
- Department of Surgery, Cantonal Hospital of Winterthur, 8401 Winterthur, Switzerland; (A.Z.); (H.G.)
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (J.L.); (P.D.); (R.A.S.)
| | - Jon Lutz
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (J.L.); (P.D.); (R.A.S.)
| | - Patrick Dorn
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (J.L.); (P.D.); (R.A.S.)
| | - Fabrizio Minervini
- Department of Thoracic Surgery, Kantonsspital Luzern, 6004 Lucerne, Switzerland; (F.M.); (P.K.)
| | - Peter Kestenholz
- Department of Thoracic Surgery, Kantonsspital Luzern, 6004 Lucerne, Switzerland; (F.M.); (P.K.)
| | - Hans Gelpke
- Department of Surgery, Cantonal Hospital of Winterthur, 8401 Winterthur, Switzerland; (A.Z.); (H.G.)
| | - Ralph A. Schmid
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (J.L.); (P.D.); (R.A.S.)
| | - Gregor J. Kocher
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (J.L.); (P.D.); (R.A.S.)
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Abstract
Minimally invasive surgical approaches to the treatment of thoracic outlet syndrome (TOS) will become increasingly common as more surgeons gain experience in thoracoscopic and robotic technique. Robotic surgery may be more technically advantageous because of improved visualization and maneuverability of wristed instruments. Longer-term outcome data are necessary to definitively establish the equivalency or superiority of minimally invasive TOS compared with open surgery in the treatment of TOS.
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Affiliation(s)
- Christina L Costantino
- Department of Thoracic Surgery, Massachusetts General Hospital, Founders House, 265 Charles Street, FND-7, Boston, MA 02114, USA
| | - Lana Y Schumacher
- Department of Thoracic Surgery, Massachusetts General Hospital, Founders House, 265 Charles Street, FND-7, Boston, MA 02114, USA.
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Furushima K, Funakoshi T, Kusano H, Miyamoto A, Takahashi T, Horiuchi Y, Itoh Y. Endoscopic-Assisted Transaxillary Approach for First Rib Resection in Thoracic Outlet Syndrome. Arthrosc Sports Med Rehabil 2021; 3:e155-e162. [PMID: 33615259 PMCID: PMC7879182 DOI: 10.1016/j.asmr.2020.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/31/2020] [Indexed: 11/03/2022] Open
Abstract
Purpose To assess the feasibility, safety, and clinical outcomes of an endoscopic-assisted transaxillary approach of first rib resection for thoracic outlet syndrome (TOS) and to compare the differences in demographic and clinical data between satisfactory and unsatisfactory outcomes using this approach. Methods We retrospectively identified patients who underwent endoscopic-assisted first rib partial resection. A transaxillary approach for the first rib resection and neurovascular decompression were undertaken under magnified visualization. Endoscopic classification of neurovascular bundle (NVB) patterns and interscalene distance (ISD) between anterior and middle scalene muscles were evaluated intraoperatively. We assessed the Roos and DASH scores. Results We reviewed 131 cases of TOS (48 women and 83 men; mean age 26.2 years; range 12 to 57). Roos classification revealed 80.2% excellent or good results. DASH scores improved significantly from 40.7 ± 20.0 to 15.7 ± 19.6 (P < .001). The complication rate was low (5.3%), with 4 pneumothorax and 3 other complications. Intraoperative NVB classification revealed 30 cases of parallel type, in which the artery and nerve travel in parallel; 69 oblique types, and 30 vertical types, in which the nerve was completely behind the middle scalene muscle or abnormal band. The ISD was narrower (5.4 ± 3.6 mm) than in previous cadaveric studies. The ISD in the parallel patterns was wider than that in the vertical patterns. In the satisfactory group, we found a significantly larger number of men, younger patients, athletes, and patients with a lower preoperative DASH score. Conclusions An endoscopic-assisted transaxillary approach for first rib resection in TOS provides an excellent magnified visualization, safely allowing sufficient decompression of the neurovascular bundle and satisfactory surgical outcomes. Younger male athletes with TOS may be better candidates for this procedure. Level of Evidence IV, therapeutic case series.
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21
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Dalio MB, Filho ERDS, Barufi MB, Ribeiro MS, Joviliano EE. Contemporary Management of Arterial Thoracic Outlet Syndrome. Ann Vasc Surg 2021; 74:42-52. [PMID: 33556514 DOI: 10.1016/j.avsg.2021.01.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/21/2020] [Accepted: 01/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Arterial thoracic outlet syndrome (aTOS) is characterized by compression of the subclavian artery as it exits the thoracic girdle. Chronic and repetitive compression leads to several degrees of arterial wall damage. The treatment is varied and depends on the presentation severity. This study aimed to describe the contemporary experience in managing arterial thoracic outlet syndrome at a large tertiary hospital. METHODS We conducted a single-institution retrospective review of aTOS cases from January 2009 to January 2020. Demographic data, clinical presentation, medical images, operative notes, and outcomes were assessed. RESULTS Thirteen aTOS cases were identified. The mean age was 43 ± 10 years, and 11 (85%) were women. Both sides were equally affected: right (7 cases, 54%) and left (6 cases, 46%). The most common clinical presentation was arm claudication (7 cases, 54%). Other presentations were: acute arm ischemia, pulsatile neck mass and distal embolization. Cervical ribs were identified by plain X-rays in most cases. All patients were submitted to surgical decompression through the supraclavicular approach. Patients with early disease stages were not submitted to arterial reconstruction and were followed with duplex scan. Arterial reconstruction was done in advanced disease stages (5 cases, 38%): end-to-end anastomosis, interposition graft, and bypass graft. The mean follow-up duration was 32,6 ± 25 months. In all patients, the subclavian artery/graft was patent, and the vascular symptoms were entirely resolved. There were no deaths or amputations. CONCLUSIONS Arterial thoracic outlet syndrome has a varied clinical presentation. Cervical ribs are the most common anatomic abnormalities. The diagnosis was based on history, physical examination, and imaging exams. Surgery consisted of supraclavicular decompression, arterial resection, and vascular reconstruction, according to the disease stage. The outcomes were excellent.
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Affiliation(s)
- Marcelo Bellini Dalio
- University of São Paulo, Ribeirão Preto Medical School, Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, Ribeirão Preto, São Paulo, Brazil.
| | - Elpídio Ribeiro da Silva Filho
- University of São Paulo, Ribeirão Preto Medical School, Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, Ribeirão Preto, São Paulo, Brazil
| | - Marina Britto Barufi
- University of São Paulo, Ribeirão Preto Medical School, Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, Ribeirão Preto, São Paulo, Brazil
| | - Maurício Serra Ribeiro
- University of São Paulo, Ribeirão Preto Medical School, Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, Ribeirão Preto, São Paulo, Brazil
| | - Edwaldo Edner Joviliano
- University of São Paulo, Ribeirão Preto Medical School, Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, Ribeirão Preto, São Paulo, Brazil
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Evaluation of functions after surgical treatment in patients with arterial thoracic outlet syndrome using QuickDASH. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:70-76. [PMID: 33768983 PMCID: PMC7970072 DOI: 10.5606/tgkdc.dergisi.2021.19810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/14/2020] [Indexed: 11/21/2022]
Abstract
Background The aim of this study was to examine the validity and reliability of the Quick Disability of the Arm, Shoulder and Hand questionnaire in patients with arterial thoracic outlet syndrome. Methods A total of 106 patients (15 males, 91 females; mean age: 30.7±10.2 years; range, 13 to 60 years) with arterial thoracic outlet syndrome were included in this prospective study between January 2015 and December 2018. The questionnaire was administered to all patients before and six months after surgery. The patients were operated using a transaxillary or supraclavicular approach under general anesthesia. Results The Cronbach"s alpha value of the questionnaire was found to be 0.85 and the scale consisted of two factors. The change in both the functional status subscale scores (p<0.001) and the physical pain subscale scores (p<0.001) were statistically significantly different before and after surgery. At the end of six months, 53% of the patients with at least one mild difficulty continued to have complaints related to hand, arm and shoulder. Conclusion Based on our study results, this questionnaire is a valid and reliable tool for measuring and monitoring disease symptoms in patients with arterial thoracic outlet syndrome.
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Dorn P, Zehnder A, Kocher GJ. [Thoracic Outlet Syndrome: Rare, Often Missed or Over-Diagnosed?]. PRAXIS 2021; 110:391-396. [PMID: 34019442 DOI: 10.1024/1661-8157/a003660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Thoracic Outlet Syndrome: Rare, Often Missed or Over-Diagnosed? Abstract. The thoracic outlet syndrome (TOS) presents with various symptoms caused by compression of the neurovascular bundle in the region of the upper thoracic aperture. Since the pathogenesis also determines the therapy of TOS, the classification according to the affected structure into neurogenic, venous and arterial TOS (nTOS, vTOS and aTOS) is useful. However, mixed forms are often to be assumed, which are then usually also classified under the term 'non-specific or disputed TOS' in the group of nTOS. In the absence of a gold standard diagnostic test, accurate history taking and clinical examination continue to be of great importance. Diagnostic experience and therapeutic advances have led to hopeful possibilities in the challenging management of this condition.
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Affiliation(s)
- Patrick Dorn
- Klinik für Thoraxchirurgie, Inselspital, Universitätsspital Bern, Bern
| | - Adrian Zehnder
- Klinik für Thoraxchirurgie, Inselspital, Universitätsspital Bern, Bern
| | - Gregor J Kocher
- Klinik für Thoraxchirurgie, Inselspital, Universitätsspital Bern, Bern
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Mitzman B. Commentary: Time to take ownership of the first rib. J Thorac Cardiovasc Surg 2020; 162:1308-1309. [PMID: 33008573 DOI: 10.1016/j.jtcvs.2020.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Brian Mitzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah.
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Shi J, Hsin M. Commentary: Do Robots Do it Better? Semin Thorac Cardiovasc Surg 2020; 32:1121-1122. [PMID: 32569646 DOI: 10.1053/j.semtcvs.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Jianxin Shi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Michael Hsin
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong.
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Pupovac SS, Lee PC, Zeltsman D, Jurado J, Hyman K, Singh V. Robotic-Assisted First Rib Resection: Our Experience and Review of the Literature. Semin Thorac Cardiovasc Surg 2020; 32:1115-1120. [PMID: 32446920 DOI: 10.1053/j.semtcvs.2020.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/20/2020] [Indexed: 11/11/2022]
Abstract
Thoracic outlet syndrome (TOS) comprises a constellation of signs and symptoms that arise from neurologic and vascular compression of the brachial plexus and subclavian vasculature, respectively. Surgical decompression of the neurovascular structures is often indicated to alleviate TOS. We report here our robotic surgical approach and experience for resection of the first rib. Between July 2014 and January 2017, 17 patients who underwent robotic-assisted first rib resection at our institution were reviewed. Nine women and 8 men with a mean age of 45 ± 11 years had a robotic-assisted first rib resection; 8 for neurogenic TOS and 9 for venous TOS. There were no complications or conversion to open surgery. The mean operative time was 113.2 ± 55.3 minutes. Length of stay was a mean of 1.8 ± 1.9 days. Length of rib resected was 5.8 ± 0.5 cm. Anticoagulation for the venous TOS cohort was Xarelto, for a mean of 5.1 ± 1.8 months. Short-term follow-up (mean 10.3 ± 4.9 days) revealed resolution of symptoms in all patients, with patent vasculature on venogram for the entire venous TOS cohort. Further follow-up at 2 months and 6 months revealed that all patients remained symptom free. Based on our institution's experience with the robotic-assisted approach to first rib resection, we feel that it is a feasible approach that could be added to the armamentarium of the thoracic surgeon.
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Affiliation(s)
- Stevan S Pupovac
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Queens, New York.
| | - Paul C Lee
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Queens, New York
| | - David Zeltsman
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Queens, New York
| | - Julissa Jurado
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Queens, New York
| | - Kevin Hyman
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Queens, New York
| | - Vijay Singh
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Queens, New York
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Burt BM, Palivela N, Karimian A, Goodman MB. Transthoracic robotic first rib resection: Twelve steps. JTCVS Tech 2020; 1:104-109. [PMID: 34317727 PMCID: PMC8288632 DOI: 10.1016/j.xjtc.2020.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 11/18/2019] [Accepted: 01/03/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Bryan M. Burt
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Address for reprints: Bryan M. Burt, MD, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.
| | - Nihanth Palivela
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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Interfascial Plane Blocks Reduce Postoperative Pain and Morphine Consumption in Thoracic Outlet Decompression. Ann Vasc Surg 2019; 66:301-308. [PMID: 31857230 DOI: 10.1016/j.avsg.2019.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Postoperative analgesia in patients undergoing transaxillary thoracic outlet decompression (TATOD) is challenging because of the invasive surgery, the complex innervation of the axillary region, and the preoperative use of opioids by many patients. Commonly, postoperative pain is managed with additional opioids that introduce well-known sideeffects. To investigate the analgesic efficacy of 2 novel regional anesthesia techniques, we performed a retrospective study comparing the combined pectoral block type 1 and erector spinae block (PECS 1 + ESB) and the pectoral block type 2 (PECS 2) and systemic intravenous opioids regimen (no block) in patients undergoing TATOD. MATERIALS AND METHODS We performed 10 PECS 1 + ESB and 10 PECS 2 blocks in patients undergoing TATOD. Twenty patients were randomly selected as controls. The primary endpoint was pain. Secondary endpoints were opioid use, nausea, and vomiting. RESULTS Postoperative maximal numeric rating scale scores on recovery were significantly lower in patients receiving either a PECS 1 + ESB or a PECS 2 block compared with controls without block (no block: median 6.00, interquartile range [IQR] 3.00; PECS 1 + ESB: median 4.50, IQR 4.00; PECS 2: median 4.00, IQR 5.00; P = 0.031). Postoperative intravenous morphine consumption was 43% lower in the PECS 1 + ESB group and 56% lower in the PECS 2 group compared with the group with no block (oral morphine equivalents; no block: mean 16.05 ± SD 6.79 mg; PECS 1 + ESB mean 9.05 ± SD 6.24 mg; PECS 2: mean 7.00 ± SD 6.16; P = 0.03 and P = 0.003, respectively). There was no statistical difference in both nausea and vomitus (no block 45% nausea and 30% vomitus, PECS 1 + ESB 40% nausea and 20% vomitus, PECS 2 10% nausea and 0% vomitus, P = 0.17 and P = 0.14, respectively). CONCLUSIONS There was a significant reduction in postoperative pain and opioid consumption for patients treated with either the PECS 1 + ESB block or PECS 2.
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Kocher GJ, Zehnder A, Lutz JA, Schmidli J, Schmid RA. First Rib Resection for Thoracic Outlet Syndrome: The Robotic Approach. World J Surg 2018; 42:3250-3255. [PMID: 29696329 DOI: 10.1007/s00268-018-4636-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE 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®. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Gregor J Kocher
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Adrian Zehnder
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jon A Lutz
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Juerg Schmidli
- Division of Cardiovascular Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ralph A Schmid
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
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Gharagozloo F, Meyer M, Tempesta B, Gruessner S. Robotic transthoracic first-rib resection for Paget–Schroetter syndrome. Eur J Cardiothorac Surg 2018; 55:434-439. [DOI: 10.1093/ejcts/ezy275] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/20/2018] [Accepted: 07/08/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Farid Gharagozloo
- Center for Advanced Thoracic Surgery, Florida Hospital Celebration Health, University of Central Florida, Celebration, FL, USA
| | - Mark Meyer
- Department of Surgery, University of Arizona Medical Center, Tucson, AZ, USA
| | - Barbara Tempesta
- Center for Advanced Thoracic Surgery, Florida Hospital Celebration Health, University of Central Florida, Celebration, FL, USA
| | - Stephan Gruessner
- Department of Surgery, University of Arizona Medical Center, Tucson, AZ, USA
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Lafosse T, Le Hanneur M, Popescu IA, Bihel T, Masmejean E, Lafosse L. All-Endoscopic Resection of an Infraclavicular Brachial Plexus Schwannoma: Surgical Technique. Arthrosc Tech 2018; 7:e869-e873. [PMID: 30167367 PMCID: PMC6112194 DOI: 10.1016/j.eats.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/13/2018] [Indexed: 02/03/2023] Open
Abstract
Due to recent progress in shoulder arthroscopy, all-endoscopic brachial plexus (BP) dissection has progressively become a standardized procedure. Based on previously described techniques, we present an additional neurological procedure that may be performed all-endoscopically, that is, the excision of an infraclavicular BP schwannoma. Starting from a standard shoulder arthroscopy with posterior and lateral portals, additional anterior and medial portals are progressively opened outside the joint under endoscopic control to access the BP. At first, dissection of the subcoracoid space allows the identification of the posterior and lateral cords, along with the axillary artery. Then, by performing a pectoralis minor tenotomy, the medial cord and axillary vein are exposed, giving access to the whole infraclavicular plexus. Intraneural dissection is performed using arthroscopic tools such as a long beaver blade, a grasper, and a smooth dissector to progressively extract the encapsulated tumor from the nerve without any damage. Using a standardized technique, endoscopy may be an advantageous tool in selected cases of BP benign peripheral nerve sheath tumors.
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Affiliation(s)
- Thibault Lafosse
- Alps Surgery Institute, Clinique Générale d’Annecy, Annecy, France,Department of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Malo Le Hanneur
- Department of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France,Address correspondence to Malo Le Hanneur, M.D., Department of Orthopaedics and Traumatology, Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital, 20 Rue Leblanc, 75015 Paris, France.
| | - Ion-Andrei Popescu
- Alps Surgery Institute, Clinique Générale d’Annecy, Annecy, France,go:h Gelenkchirurgie Orthopädie Hannover, Hannover, Germany
| | - Thomas Bihel
- Department of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Emmanuel Masmejean
- Department of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Laurent Lafosse
- Alps Surgery Institute, Clinique Générale d’Annecy, Annecy, France
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Aghayev K, Ciklatekerlio O. Posterior Upper Rib Excision for Neurogenic Thoracic Outlet Syndrome---Feasibility and Early Outcomes. Oper Neurosurg (Hagerstown) 2018; 14:532-537. [PMID: 29106657 DOI: 10.1093/ons/opx143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/06/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are several surgical treatment options for neurogenic thoracic outlet syndrome (n-TOS). However, the first rib has been shown to be the common denominator of all TOS forms and the degree of its resection has been shown to correlate with the long-term success. OBJECTIVE To demonstrate the feasibility of posterior upper rib excision (PURE) and report early outcomes. METHODS Nine patients presented with signs and symptoms of n-TOS. Preoperative evaluation involved physical and neurological examination, arm visual analog score (VAS), cervical X-ray, magnetic resonance imaging (MRI) of the cervical spine, and brachial plexus MRI. All patients were operated at a single institution by a single surgeon. Postoperatively, clinical and radiological data were collected. RESULTS There were 2 men and 7 women in the study with 10 procedures performed. The age range was 18 to 45 with mean of 36.6 yr. Mean preoperative arm visual analog scale score was 7.8. The patients underwent posterior upper rib excision (PURE) by a single surgeon. One patient had bilateral surgery. The causes of TOS were fibrous bands, enlarged C7 transverse processes, narrow scalene triangle, and accessory ribs. All patients improved after surgery in terms of arm pain and quality of life. Postoperative mean visual analog scale score was 1.1 at 6 mo. In addition, neurological examination was normal at 6 mo postoperatively and all patients returned to their previous full-time jobs. CONCLUSION Posterior upper rib excision is a feasible surgical option for n-TOS.
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Affiliation(s)
- Kamran Aghayev
- Department of Neurosurgery, Biruni Uni-versity, Istanbul, Turkey
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33
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Thoracic outlet syndrome for thoracic surgeons. J Thorac Cardiovasc Surg 2018; 156:1318-1323.e1. [PMID: 29628349 DOI: 10.1016/j.jtcvs.2018.02.096] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/06/2018] [Accepted: 02/11/2018] [Indexed: 11/21/2022]
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Nuutinen H, Riekkinen T, Aittola V, Mäkinen K, Kärkkäinen JM. Thoracoscopic Versus Transaxillary Approach to First Rib Resection in Thoracic Outlet Syndrome. Ann Thorac Surg 2018; 105:937-942. [DOI: 10.1016/j.athoracsur.2017.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/14/2017] [Accepted: 10/02/2017] [Indexed: 11/16/2022]
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Wightman SC, Angelos P. Ethical aspects of a video-assisted thoracoscopic surgery practice. J Vis Surg 2017; 3:8. [PMID: 29078571 DOI: 10.21037/jovs.2016.12.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 11/06/2022]
Abstract
Thoracic surgery is a field encompassing many diverse operative techniques ranging from open surgeries involving thoracotomies and sternotomies to less invasive operations such as video-assisted thoracoscopic surgery (VATS), endoscopy, and bronchoscopy. The popularity and acceptance of VATS has been increasing over time. Ethical considerations must be used to navigate patient misconceptions of VATS surgery, creating an appropriate informed consent process, determining appropriate patients for VATS, training future thoracic surgeons in VATS, and advancing thoracic surgery innovation. Thoracic surgeons are the gateway to determine what operation and what technique is appropriate to offer to each patient. This requires strict adherence to ethical standards as well as self-regulation.
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Affiliation(s)
- Sean C Wightman
- Department of Surgery, the University of Chicago, Chicago, Illinois, USA
| | - Peter Angelos
- Department of Surgery, the University of Chicago, Chicago, Illinois, USA
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Arterial Thoracic Outlet Syndrome Treated Successfully with Totally Endoscopic First Rib Resection. Case Rep Pulmonol 2017; 2017:9350735. [PMID: 28845317 PMCID: PMC5563393 DOI: 10.1155/2017/9350735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/23/2017] [Accepted: 07/06/2017] [Indexed: 12/01/2022] Open
Abstract
Thoracic outlet syndrome (TOS) is a constellation of signs and symptoms caused by compression of the neurovascular structures in the thoracic outlet. TOS may be classified as either neurogenic TOS (NTOS) or vascular TOS: venous TOS (VTOS) or arterial TOS (ATOS), depending on the specific structure being affected. The basis for the surgical treatment of TOS is resection of the first rib, and it may be combined with scalenectomy or cervical rib resection. Herein, we describe a case of arterial thoracic outlet syndrome which was successfully treated with totally endoscopic video-assisted thoracoscopic surgery (VATS) first rib resection.
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New Diagnostic and Treatment Modalities for Neurogenic Thoracic Outlet Syndrome. Diagnostics (Basel) 2017; 7:diagnostics7020028. [PMID: 28555024 PMCID: PMC5489948 DOI: 10.3390/diagnostics7020028] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/07/2017] [Accepted: 05/24/2017] [Indexed: 11/30/2022] Open
Abstract
Neurogenic thoracic outlet syndrome is a widely recognized, yet controversial, syndrome. The lack of specific objective diagnostic modalities makes diagnosis difficult. This is compounded by a lack of agreed upon definitive criteria to confirm diagnosis. Recent efforts have been made to more clearly define a set of diagnostic criteria that will bring consistency to the diagnosis of neurogenic thoracic syndrome. Additionally, advancements have been made in the quality and techniques of various imaging modalities that may aid in providing more accurate diagnoses. Surgical decompression remains the mainstay of operative treatment; and minimally invasive techniques are currently in development to further minimize the risks of this procedure. Medical management continues to be refined to provide non-operative treatment modalities for certain patients, as well. The aim of the present work is to review these updates in the diagnosis and treatment of neurogenic thoracic outlet syndrome.
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Kara HV. Editorial on Totally endoscopic (VATS) first rib resection for thoracic outlet syndrome. J Thorac Dis 2017; 9:19-21. [PMID: 28203402 DOI: 10.21037/jtd.2017.01.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- H Volkan Kara
- Department of Thoracic Surgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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39
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Povlsen B. Comments: totally endoscopic (VATS) first rib resection for thoracic outlet syndrome. J Thorac Dis 2017; 8:E1739-E1740. [PMID: 28149627 DOI: 10.21037/jtd.2016.12.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Bo Povlsen
- Department of Orthopaedic Surgery, Guy's & St Thomas' Hospital, London, UK
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40
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Vos CG, Ünlü Ç, de Vries JPP. Commentary on 'Totally Endoscopic (VATS) First Rib Resection for Thoracic Outlet Syndrome'. J Thorac Dis 2017; 8:3046-3048. [PMID: 28066579 DOI: 10.21037/jtd.2016.11.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Cornelis G Vos
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Çağdaş Ünlü
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
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