Surgical resection of the first rib can be an effective means of relieving thoracic outlet syndrome.

The thoracic outlet is a space located between your collarbone and first rib. Thoracic outlet syndrome refers to a group of symptoms that occur when the blood vessels or nerves in this area become compressed resulting in either shoulder or neck pain or numbness in the fingers. Thoracic outlet syndrome is commonly attributed to physical trauma from a car accident and repetitive injuries from on-the-job or sports-related activities.

There are three types of thoracic outlet syndrome.

• Neurogenic (neurological) thoracic outlet syndrome. Characterized by compression of the brachial plexus. The brachial plexus is a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand. The majority of thoracic outlet syndrome cases are neurogenic.
• Vascular thoracic outlet syndrome. One or more of the arteries and veins under the clavicle (subclavian vessels) are compressed.
• Nonspecific-type thoracic outlet syndrome. People with nonspecific-type thoracic outlet syndrome have chronic pain in the area of the thoracic outlet, but the specific cause of the pain can't be determined.

Surgical Treatment
Your physician may recommend surgical treatment to relieve the pain associated with thoracic outlet syndrome. The goal of surgery is to identify and correct the cause of the compression, which can be a result of an abnormality of the tendons, the muscles or the bones that make up the thoracic outlet. A rib resection is designed to relieve compression caused by the first rib or other structures.

Robotic Surgery
The daVinci robot has been used in a minimally invasive robotic thoracoscopic approach for complete resection of the first rib. This technique allows for complete resection of the first rib, and is associated with a lower likelihood of neurovascular complications compared to other techniques.