Port-access first-rib resection

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.