Hoexum Frank, Jongkind Vincent, Coveliers Hans Me, Yeung Kak K, Wisselink Willem
Cardiovascular Sciences, Department of Vascular Surgery, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.
General District Hospital, Aalst, Belgium.
Vascular. 2022 Apr;30(2):217-224. doi: 10.1177/1708538121997332. Epub 2021 Apr 9.
Venous thoracic outlet syndrome (vTOS) is caused by external compression of the subclavian vein at the costoclavicular junction. It can be subdivided in McCleery Syndrome and Paget-Schroetter Syndrome (PSS). To improve the venous outflow of the arm and to prevent recurrent thrombosis, first rib resection with venolysis of the subclavian vein can be performed. Open transaxillary, supraclavicular, infraclavicular or combined paraclavicular approaches are well known, but more recent robot-assisted techniques are introduced. We report our short- and long-term results of a minimal invasive transthoracic approach for resection of the anteromedial part of the first rib using the DaVinci surgical robot, performed through three trocars.
We analyzed all patients with vTOS who were scheduled to undergo robot-assisted transthoracic first rib resection in the period July 2012 to May 2016. Outcomes were: technical success, operation time, blood loss, hospital stay, 30-day complications and patency. Functional outcomes were assessed using the "Disability of the Arm, Shoulder and Hand" (DASH) questionnaire.
Fifteen patients (8 male, 7 female; mean age 32.9 years, range 20-54 years) underwent robot-assisted transthoracic first rib resection. Conversion to transaxillary resection was necessary in three patients. Average operation time was 147.9 min (range 88-320 min) with a mean blood loss of 79.5 cc (range 10-550 cc). Mean hospital stay was 3.5 days (range 2-9). In three patients, complications were reported (Clavien-Dindo grade 2-3a). Patency was 91% at 15.5 months' follow-up. DASH scores at one and three years showed excellent functional outcomes (7.1 (SD= 6.9, range 0-20.8) and 6.0 (SD= 6.4, range 0-25)) and are comparable to the scores of the normative general population.
Robot-assisted transthoracic first rib resection with only three trocars is a feasible minimal invasive approach for first rib resection in the management of vTOS. This technique enables the surgeon to perform venolysis under direct 3D vision with good patency and long-term functional outcome. Studies with larger cohort size are needed to compare the outcomes of this robot-assisted technique with other more established approaches.
静脉型胸廓出口综合征（vTOS）是由锁骨下静脉在肋锁关节处受到外部压迫所致。它可细分为麦克利里综合征和佩吉特-施罗特综合征（PSS）。为改善手臂的静脉流出并预防复发性血栓形成，可进行第一肋切除并对锁骨下静脉进行静脉松解术。开放经腋窝、锁骨上、锁骨下或联合锁骨旁入路是众所周知的，但最近引入了机器人辅助技术。我们报告了使用达芬奇手术机器人通过三个套管针进行的微创经胸入路切除第一肋前内侧部分的短期和长期结果。
我们分析了2012年7月至2016年5月期间计划接受机器人辅助经胸第一肋切除的所有vTOS患者。结果包括：技术成功率、手术时间、失血量、住院时间、30天并发症和通畅情况。使用“手臂、肩部和手部功能障碍”（DASH）问卷评估功能结果。
15例患者（8例男性，7例女性；平均年龄32.9岁，范围20 - 54岁）接受了机器人辅助经胸第一肋切除。3例患者需要转为经腋窝切除。平均手术时间为147.9分钟（范围88 - 320分钟），平均失血量为79.5毫升（范围10 - 550毫升）。平均住院时间为3.5天（范围2 - 9天）。3例患者报告有并发症（Clavien-Dindo分级2 - 3a）。随访15.5个月时通畅率为91%。1年和3年时的DASH评分显示功能结果极佳（7.1（标准差= 6.9，范围0 - 20.8）和6.0（标准差= 6.4，范围0 - 25）），与正常普通人群的评分相当。
仅通过三个套管针进行的机器人辅助经胸第一肋切除是治疗vTOS时第一肋切除的一种可行的微创方法。该技术使外科医生能够在直接3D视野下进行静脉松解术，通畅率良好且长期功能结果佳。需要更大样本量的研究来比较这种机器人辅助技术与其他更成熟方法的结果。
