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Video Assisted Transaxillary First Rib Resection for Venous Thoracic Outlet Sydrome
Daniel H. Newton, MD, Benjamin M. Jackson, MD, MS, Ronald M. Fairman, MD, Scott Damrauer, MD, Grace J. Wang, MD, Paul J. Foley, MD.
University of Pennsylvania, Philadelphia, PA, USA.

OBJECTIVES: In this video, we demonstrate transaxillary first rib resection technique and highlight the advantages of video-assistance.
METHODS: The laparoscopic tower is positioned above the patientís head. An axillary incision is made and dissection carried to the first rib. Using a 30-degree laparoscope, the first rib, subclavian vein, artery, and brachial plexus can be dissected with confidence. The first rib is removed under direct visualization.
RESULTS: The video assisted technique improves visualization, and requires no change in approach or exposure. Anecdotally, it shortens the learning curve for trainees since they can better see the necessary maneuvers.
CONCLUSIONS: Video-assistance can be easily added to an otherwise standard transaxillary first rib resection. The resulting improvement in visualization is especially useful for training future surgeons to perform this procedure.


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