Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Ann Surg. 2023 Jun 1;277(6):e1215-e1216. doi: 10.1097/SLA.0000000000005232. Epub 2021 Sep 29.
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.
We describe a novel transthoracic robotic approach to first/cervical rib resection that overcomes these limitations, and we review its early clinical outcomes.
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.
Robotic FRR offers advantages over traditional operative approaches including improved exposure and elimination of retraction of neurovascular structures, which result in improved safety.
神经源性胸廓出口综合征（TOS）是一种肌肉骨骼疾病，臂丛神经在斜角肌三角内受到动态压迫，该三角由前斜角肌、中斜角肌和第一肋骨构成。在某些情况下，会出现有问题的颈肋。传统的第一肋骨切除和斜角肌切除术的手术方法受到暴露范围的限制，需要牵拉神经血管结构，导致发病率增加。
我们描述了一种新的经胸机器人辅助第一/颈肋切除术方法，克服了这些限制，并回顾了其早期的临床结果。
机器人第一肋骨切除术（FRR）被分为 12 个不同的步骤，每个步骤都有详细的视频解说，并提供了神经源性和静脉型 TOS 病例的具体细节。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。
机器人 FRR 与传统手术方法相比具有优势，包括改善暴露和消除神经血管结构的牵拉，从而提高了安全性。
