Transaxillary first rib resection from an endoscopic concept to robotic technology, 30 years of experience
Epublication WebSurg.com, Jan 2014;14(01). URL: http://websurg.com/doi/lt03enmartinez001
Introduction: Our interest in minimally invasive vascular surgery dates back to 1982. We designed our endoscope, attached to a micro-video camera, making the transaxillary first rib and cervical band resection safer for the surgical treatment of disabling thoracic outlet syndrome. Over the following two decades, we evolved with the rapid technological development of minimally invasive surgery. Material and methods: 644 total surgical procedures were performed between 1983 and 2013, including various stages. Video presentation of the “final product” in evolution during the past 10 years using the da Vinci® robotic system will be shown. Results: There were no mortalities, no permanent nerve, artery, or vein damage. The following could be noted: 8% complications, 4% respiratory, 3% temporary neurological dysfunctions, 0.8% infection, 0.4% transient renal insufficiency. Conversion rate was 1.1%, scar tissue formation of 0.4%, and length of stay: 3.3 days. Conclusions: The endoscopic transaxillary approach has helped us to understand the pathogenesis of the cervical bands frequently present in thoracic outlet syndrome. The procedure has evolved over the last 3 decades and the da Vinci® robotic system definitely offers great advantages, improving the surgical procedure and clinical outcome.