Reyes Maikerly, Alaparthi Sneha, Roedl Johannes B, Moreta Marisa C, Evans Nathaniel R, Grenda Tyler, Okusanya Olugbenga T
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Department of Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
J Clin Med. 2023 Oct 23;12(20):6689. doi: 10.3390/jcm12206689.
Thoracic outlet syndrome (TOS) involves the compression of neurovascular structures in the thoracic outlet. TOS subtypes, including neurogenic (nTOS), venous (vTOS), and arterial (aTOS) are characterized by distinct clinical presentations and diagnostic considerations. This review explores the incidence, diagnostic challenges, and management of TOS with a focus on the innovative approach of Robotic First Rib Resection (R-FRR). Traditional management of TOS includes conservative measures and surgical interventions, with various open surgical approaches carrying risks of complications. R-FRR, a minimally invasive technique, offers advantages such as improved exposure, reduced injury risk to neurovascular structures, and shorter hospital stays. A comprehensive literature review was conducted to assess the outcomes of R-FRR for TOS. Data from 12 selected studies involving 397 patients with nTOS, vTOS, and aTOS were reviewed. The results indicate that R-FRR is associated with favorable intraoperative outcomes including minimal blood loss and low conversion rates to traditional approaches. Postoperatively, patients experienced decreased pain, improved function, and low complication rates. These findings support R-FRR as a safe and effective option for medically refractory TOS.
胸廓出口综合征（TOS）涉及胸廓出口处神经血管结构的受压。TOS的亚型，包括神经源性（nTOS）、静脉性（vTOS）和动脉性（aTOS），具有不同的临床表现和诊断考量。本综述探讨了TOS的发病率、诊断挑战及治疗，重点关注机器人第一肋切除术（R-FRR）的创新方法。TOS的传统治疗包括保守措施和手术干预，各种开放手术方法都有并发症风险。R-FRR作为一种微创技术，具有诸如改善视野暴露、降低神经血管结构损伤风险以及缩短住院时间等优势。进行了一项全面的文献综述以评估R-FRR治疗TOS的效果。对12项选定研究的数据进行了回顾，这些研究涉及397例患有nTOS、vTOS和aTOS的患者。结果表明，R-FRR与良好的术中结果相关，包括出血量极少以及转为传统手术方法的转化率低。术后，患者疼痛减轻、功能改善且并发症发生率低。这些发现支持R-FRR作为药物难治性TOS的一种安全有效的选择。
