Kim In Ha, Kim Yong-Hee
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Thorac Dis. 2025 Jul 31;17(7):4610-4620. doi: 10.21037/jtd-2025-363. Epub 2025 Jul 21.
Thoracic outlet syndrome (TOS) is a group of disorders caused by compression of the neurovascular bundle as it exits the thoracic outlet. The treatment involves first rib resection (FRR) via open surgery or minimally invasive surgery. This study compares the surgical outcomes of the supraclavicular approach and robotic-assisted thoracic surgery (RATS).
We retrospectively reviewed the clinicopathological and perioperative data of patients with TOS who underwent surgery between October 2005 and July 2024.
A total of 23 operations were performed on 21 patients (median age, 28 years; range, 21-68 years), with 8 (38.1%) being female. The median body mass index (BMI) was 23.7 kg/m (range, 20.5-42.5 kg/m), and 15 patients had neurogenic TOS (nTOS). Among the 23 cases, robotic FRR was performed in 13 cases. The median operation time was 96 min (range, 63-211 min), and the median highest pain score on the numeric rating scale (NRS) was 3 (range, 1-7). One patient (4.3%) experienced subclavian artery injury which was successfully repaired without sequelae. Based on the Derkash classification, clinical outcomes were categorized as "excellent", which was the most prevalent category, in 19 patients (82.6%). The median subjective improvement was 95% (range, 60-100%). Postoperative peak NRS scores were better with robotic FRR compared to the supraclavicular approach (3 4.5; P=0.02).
In appropriately selected patients, both supraclavicular and robotic FRR yield excellent surgical outcomes. However, given its various advantages, robotic FRR should be considered the new gold standard when a robotic system is available at the institution.
胸廓出口综合征（TOS）是一组因神经血管束穿出胸廓出口时受压而引起的疾病。治疗方法包括通过开放手术或微创手术进行第一肋切除术（FRR）。本研究比较了锁骨上入路和机器人辅助胸外科手术（RATS）的手术效果。
我们回顾性分析了2005年10月至2024年7月期间接受手术的TOS患者的临床病理和围手术期数据。
共对21例患者进行了23次手术（中位年龄28岁；范围21 - 68岁），其中女性8例（38.1%）。中位体重指数（BMI）为23.7 kg/m（范围20.5 - 42.5 kg/m），15例患者患有神经源性TOS（nTOS）。在这23例病例中，13例进行了机器人辅助FRR。中位手术时间为96分钟（范围63 - 211分钟），数字评分量表（NRS）上的中位最高疼痛评分为3分（范围1 - 7分）。1例患者（4.3%）发生锁骨下动脉损伤，成功修复且无后遗症。根据Derkash分类，19例患者（82.6%）的临床结果被归类为“优秀”，这是最常见的类别。主观改善的中位值为95%（范围60 - 100%）。与锁骨上入路相比，机器人辅助FRR术后的NRS峰值评分更好（3对4.5；P = 0.02）。
在适当选择的患者中，锁骨上入路和机器人辅助FRR均能产生优异的手术效果。然而，鉴于其诸多优势，当机构具备机器人系统时，机器人辅助FRR应被视为新的金标准。
