Endoscopically assisted transaxillary release of the scalene muscles for thoracic outlet syndromes: a comparison with or without first rib resection

• Published in: General thoracic and cardiovascular surgery Vol. 72; no. 7; pp. 487 - 494
• Main Authors: Satake, Hiroshi, Nito, Toshiya, Naganuma, Yasushi, Maruyama, Masahiro, Hanaka, Naomi, Uno, Tomohiro, Takagi, Michiaki
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01-07-2024; Springer Nature B.V
• Subjects: Adolescent; Adult; Cardiac Surgery; Cardiology; Decompression, Surgical - methods; Endoscopy - methods; Female; Females; Humans; Male; Medical imaging; Medicine; Medicine & Public Health; Mental disorders; Middle Aged; Original Article; Patient satisfaction; Retrospective Studies; Ribs - surgery; Surgery; Surgical Oncology; Thoracic Outlet Syndrome - surgery; Thoracic Surgery; Time Factors; Treatment Outcome; Ultrasonic imaging; Veins & arteries; Ventilation; Young Adult; First rib resection; Endoscopic surgery; TOS; Scalenectomy; Scalenotomy
• ISSN: 1863-6705; 1863-6713; 1863-6713
• DOI: 10.1007/s11748-024-02031-z

Objectives
There are several surgical techniques for thoracic outlet syndrome (TOS). However, there have been no reports of endoscopically assisted transaxillary release of the anterior and middle scalene muscles (EATRS), leaving the first rib intact for TOS. We hypothesized that EATRS would achieve a good Quick Disability of the Arm, Shoulder and Hand score. This study aims to present our experience with a new technique for TOS using endoscopy.
Methods
We chose two surgeries depending on the patient’s TOS condition. If the costoclavicular space was under 12 mm, we selected endoscopically assisted transaxillary first rib resection (EAFRR). If the costoclavicular space was over 12 mm, we selected EATRS. Between January 2021 and December 2022, 31 consecutive surgeries for TOS were performed in our institution. Twenty-five patients underwent EAFRR, and six (19%) underwent EATRS. Since July 2022, EAFRR has been performed under differential lung ventilation.
Results
Complete and almost complete relief was achieved in 24 patients (77%), and partial relief was conducted in seven patients (23%) at a mean of 19.7 months after surgery. The symptoms improved in all cases. Intraoperative pneumothorax did not occur, and no other complications were observed. Both EAFRR and EATRS were effective and safe surgeries for TOS. Operative time was significantly shorter in EATRS than in EAFRR.
Conclusions
We first report EATRS surgery for TOS. EATRS is indicated for patients whose costoclavicular space is preserved before surgery. Good surgical results were obtained after surgery for this indication.