Robotic en bloc first-rib resection for paget-schroetter disease, a form of thoracic outlet syndrome: Technique and initial results

Farid Gharagozloo, Mark Meyer, Barbara J. Tempesta, Marc Margolis, Eric T. Strother, Srini Tummala

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


OBJECTIVE: First-rib resection is a key component of the treatment of Paget-Schroetter disease. There are many controversies regarding the management of this disease. We report a safe, effective, minimally invasive robotic transthoracic approach for resection of the first rib. METHODS: Over an 8-month period, five patients underwent robotic first-rib resection. Preoperative assessment included physical examination and bilateral venous angiography. On a thoracoscopic platform using three 2-cm incisions and one 1-cm incision, the robot was used to dissect the first rib and divide the scalene muscles. Success of the first-rib resection was assessed by postoperative venous angiography. RESULTS: There were four men and one woman. Mean age was 34.6 ± 10 years. Mean operative time was 195 ± 24.6 minutes. There were no complications and no mortality. All patients had a patent subclavian vein on the postoperative venogram and were anticoagulated with warfarin for 3 months. At a median follow-up of 12 months, all patients had an open subclavian vein for a patency rate of 100%. CONCLUSIONS: Robotic thoracoscopic first-rib resection represents a feasible minimally invasive approach to en bloc resection of the first rib. This technique minimizes the risk of neurovascular complications that are associated with conventional techniques.

Original languageEnglish (US)
Pages (from-to)39-44
Number of pages6
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Issue number1
StatePublished - 2012
Externally publishedYes


  • Paget-Schroetter disease
  • Paget-Schroetter syndrome
  • Robotic thoracoscopic first-rib resection
  • Technique
  • Thoracic outlet syndrome

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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