Robotic transthoracic first-rib resection for Paget-Schroetter syndrome

OBJECTIVES First-rib resection is a key component in the treatment of Paget-Schroetter syndrome. We report our experience with robotic first-rib resection. METHODS Patients diagnosed with Paget-schroetter syndrome underwent thrombolysis followed by robotic first-rib resection. The diagnosis was made by preoperative venography (VA) and magnetic resonance venography. The robot was used to dissect the first rib, disarticulate the costosternal joint and divide the scalene muscles. Success of the first-rib resection was assessed by physical examination, venogram and magnetic resonance venography. RESULTS Eighty-three robotic first-rib resections were performed (49 men and 34 women). The mean age of the patients was 24years8.5years. The operative time was 127.6min +/- 20.8min. The median hospitalization was 4days. There were no surgical complications, neurovascular injuries or mortality. Patients with a patent subclavian vein on the postoperative venogram (57 of 83 patients, 69%) were anticoagulated with warfarin for 3months. In the remaining 27 patients with a persistent postoperative occlusion of the subclavian vein, 21 (21 of 83 patients, 24%) underwent angioplasty and were anticoagulated with warfarin for 3months, and 6 (6 of 83, 7%) required stent placement to achieve complete vein patency. Patients who underwent stent placement received antiplatelet therapy in addition to warfarin anticoagulation for 3months. At a median follow-up of 24months, all patients had an open subclavian vein with a patency rate of 100%. CONCLUSIONS The robotic transthoracic first-rib resection is feasible and allows for a minimally invasive resection of the first rib, while minimizing neurovascular complications.