We have developed a thoracoscopic first rib resection technique for treatme
nt of thoracic outlet syndrome (TOS), employing new instruments designed fo
r endoscopic surgery. A 49-year-old man with Paget-Schroetter syndrome was
treated bilaterally, and a 25-year-old woman with neurologic symptoms was t
reated on the right side by thoracoscopic approach via three ports. Harmoni
c scalpel, endoscopic elevators, rongeurs, and an endoscopic drill were use
d. In two patients, approximately 80% of the first rib overlying the subcla
vian vessels and brachial plexus was successfully removed by this technique
. We conclude that port-access first-rib resection is feasible and reproduc
ible using the new instruments described.