Complications Of Endoscopic-Assisted First Rib Resection For Thoracic Outlet Syndrome.
Hisao Shimokobe, Md PhD1; Kozo Furushima, MD PhD2; Tadanao Funakoshi, MD PhD3; Toru Takahasi, MD4
1Orthopedic, Kitakyushu, Japan; 2Orthopedic, Tatebayshi, Japan; 3Orthopedic, Tatebayashi, Japan; 4Orthopedic, Tatebayashi Gunma, Japan
Introduction Thoracic outlet syndrome is a disorder with a variety of symptoms caused by compression of the brachial plexus and subclavian vessels. We perform endoscopic assisted transaxillary approach first rib resection and neurovascular dissection. The surgical field is closely related to the subclavian artery and brachial plexus, and possible complications can be serious. In this study, we examined the intraoperative complications caused by this technique and investigated the incidence of such complications.
Materials & Methods We included 537 patients who underwent first rib resection from April 2017 to April 2021. The procedure was performed under general anesthesia in the side-lying position with the upper limb in 90-degree abduction with traction on the upper limb, and the transaxillary approach was performed through a 5-8 m skin incision at the level of the 5th~6th rib. The subclavian artery was identified endoscopically, the anterior and middle scalene muscles were separated at the first rib stop, and the first rib was resected as much as possible piece by piece. Possible intraoperative complications included brachial plexus injury, injury to the subclavian arteriovenous vein, incidence of pleural injury and pneumothorax and their treatment, and incidence of mediastinal emphysema.
Results No obvious brachial plexus or subclavian arteriovenous injuries were observed. A total of 39 patients (7.2%) had pleural injuries intraoperatively or postoperatively. Of these, 16 cases had obvious intraoperative pleural injury, and 23 cases had postoperative radiographic evidence of pleural injury. Thoracic drain insertion was necessary in 28 patients (5.2%). The average duration of trocar insertion was 1.2 days. Mediastinal emphysema occurred in 4 patients (1.3%), but all cases resolved spontaneously. No life-threatening complications or paralytic symptoms were observed after surgery in any of the patients.
Conclusion Transaxillary first rib resection for thoracic outlet syndrome has been performed successfully at our hospital. The use of an arthroscope allows detailed observation of the area around the vascular nerve bundle and allows dissection and treatment. As a result, we believe that serious complications such as vascular injury and pneumothorax can be minimized
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