Robotic transthoracic first-rib resection for Paget-Schroetter syndrome

Farid - Gharagozloo, Mark Meyer, Barbara Tempesta, Stephan Gruessner

Research output: Contribution to journalArticle

Abstract

First-rib resection is a key component in the treatment of Paget-Schroetter syndrome. We report our experience with robotic first-rib resection. METHODS: Patients diagnosed with Paget-schroetter syndrome underwent thrombolysis followed by robotic first-rib resection. The diagnosis was made by preoperative venography (VA) and magnetic resonance venography. The robot was used to dissect the first rib, disarticulate the costosternal joint and divide the scalene muscles. Success of the first-rib resection was assessed by physical examination, venogram and magnetic resonance venography. RESULTS: Eighty-three robotic first-rib resections were performed (49 men and 34 women). The mean age of the patients was 24 years 8.5 years. The operative time was 127.6 min 20.8 min. The median hospitalization was 4 days. There were no surgical complications, neurovascular injuries or mortality. Patients with a patent subclavian vein on the postoperative venogram (57 of 83 patients, 69%) were anticoagulated with warfarin for 3 months. In the remaining 27 patients with a persistent postoperative occlusion of the subclavian vein, 21 (21 of 83 patients, 24%) underwent angioplasty and were anticoagulated with warfarin for 3 months, and 6 (6 of 83, 7%) required stent placement to achieve complete vein patency. Patients who underwent stent placement received antiplatelet therapy in addition to warfarin anticoagulation for 3 months. At a median follow-up of 24 months, all patients had an open subclavian vein with a patency rate of 100%. CONCLUSIONS: The robotic transthoracic first-rib resection is feasible and allows for a minimally invasive resection of the first rib, while minimizing neurovascular complications.

Original languageEnglish (US)
Pages (from-to)434-439
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume55
Issue number3
DOIs
StatePublished - Mar 1 2019
Externally publishedYes

Fingerprint

Upper Extremity Deep Vein Thrombosis
Robotics
Ribs
Subclavian Vein
Phlebography
Warfarin
Stents
Magnetic Resonance Spectroscopy
Operative Time
Angioplasty
Physical Examination
Veins
Hospitalization
Joints
Muscles

Keywords

  • Minimally invasive surgery
  • Paget-Schroetter syndrome
  • Robotic surgery
  • Thoracic outlet syndrome

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Robotic transthoracic first-rib resection for Paget-Schroetter syndrome. / Gharagozloo, Farid -; Meyer, Mark; Tempesta, Barbara; Gruessner, Stephan.

In: European Journal of Cardio-thoracic Surgery, Vol. 55, No. 3, 01.03.2019, p. 434-439.

Research output: Contribution to journalArticle

Gharagozloo, Farid - ; Meyer, Mark ; Tempesta, Barbara ; Gruessner, Stephan. / Robotic transthoracic first-rib resection for Paget-Schroetter syndrome. In: European Journal of Cardio-thoracic Surgery. 2019 ; Vol. 55, No. 3. pp. 434-439.
@article{b54ecc3759ab454fb8dfe0f28a05977b,
title = "Robotic transthoracic first-rib resection for Paget-Schroetter syndrome",
abstract = "First-rib resection is a key component in the treatment of Paget-Schroetter syndrome. We report our experience with robotic first-rib resection. METHODS: Patients diagnosed with Paget-schroetter syndrome underwent thrombolysis followed by robotic first-rib resection. The diagnosis was made by preoperative venography (VA) and magnetic resonance venography. The robot was used to dissect the first rib, disarticulate the costosternal joint and divide the scalene muscles. Success of the first-rib resection was assessed by physical examination, venogram and magnetic resonance venography. RESULTS: Eighty-three robotic first-rib resections were performed (49 men and 34 women). The mean age of the patients was 24 years 8.5 years. The operative time was 127.6 min 20.8 min. The median hospitalization was 4 days. There were no surgical complications, neurovascular injuries or mortality. Patients with a patent subclavian vein on the postoperative venogram (57 of 83 patients, 69{\%}) were anticoagulated with warfarin for 3 months. In the remaining 27 patients with a persistent postoperative occlusion of the subclavian vein, 21 (21 of 83 patients, 24{\%}) underwent angioplasty and were anticoagulated with warfarin for 3 months, and 6 (6 of 83, 7{\%}) required stent placement to achieve complete vein patency. Patients who underwent stent placement received antiplatelet therapy in addition to warfarin anticoagulation for 3 months. At a median follow-up of 24 months, all patients had an open subclavian vein with a patency rate of 100{\%}. CONCLUSIONS: The robotic transthoracic first-rib resection is feasible and allows for a minimally invasive resection of the first rib, while minimizing neurovascular complications.",
keywords = "Minimally invasive surgery, Paget-Schroetter syndrome, Robotic surgery, Thoracic outlet syndrome",
author = "Gharagozloo, {Farid -} and Mark Meyer and Barbara Tempesta and Stephan Gruessner",
year = "2019",
month = "3",
day = "1",
doi = "10.1093/ejcts/ezy275",
language = "English (US)",
volume = "55",
pages = "434--439",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "Elsevier",
number = "3",

}

TY - JOUR

T1 - Robotic transthoracic first-rib resection for Paget-Schroetter syndrome

AU - Gharagozloo, Farid -

AU - Meyer, Mark

AU - Tempesta, Barbara

AU - Gruessner, Stephan

PY - 2019/3/1

Y1 - 2019/3/1

N2 - First-rib resection is a key component in the treatment of Paget-Schroetter syndrome. We report our experience with robotic first-rib resection. METHODS: Patients diagnosed with Paget-schroetter syndrome underwent thrombolysis followed by robotic first-rib resection. The diagnosis was made by preoperative venography (VA) and magnetic resonance venography. The robot was used to dissect the first rib, disarticulate the costosternal joint and divide the scalene muscles. Success of the first-rib resection was assessed by physical examination, venogram and magnetic resonance venography. RESULTS: Eighty-three robotic first-rib resections were performed (49 men and 34 women). The mean age of the patients was 24 years 8.5 years. The operative time was 127.6 min 20.8 min. The median hospitalization was 4 days. There were no surgical complications, neurovascular injuries or mortality. Patients with a patent subclavian vein on the postoperative venogram (57 of 83 patients, 69%) were anticoagulated with warfarin for 3 months. In the remaining 27 patients with a persistent postoperative occlusion of the subclavian vein, 21 (21 of 83 patients, 24%) underwent angioplasty and were anticoagulated with warfarin for 3 months, and 6 (6 of 83, 7%) required stent placement to achieve complete vein patency. Patients who underwent stent placement received antiplatelet therapy in addition to warfarin anticoagulation for 3 months. At a median follow-up of 24 months, all patients had an open subclavian vein with a patency rate of 100%. CONCLUSIONS: The robotic transthoracic first-rib resection is feasible and allows for a minimally invasive resection of the first rib, while minimizing neurovascular complications.

AB - First-rib resection is a key component in the treatment of Paget-Schroetter syndrome. We report our experience with robotic first-rib resection. METHODS: Patients diagnosed with Paget-schroetter syndrome underwent thrombolysis followed by robotic first-rib resection. The diagnosis was made by preoperative venography (VA) and magnetic resonance venography. The robot was used to dissect the first rib, disarticulate the costosternal joint and divide the scalene muscles. Success of the first-rib resection was assessed by physical examination, venogram and magnetic resonance venography. RESULTS: Eighty-three robotic first-rib resections were performed (49 men and 34 women). The mean age of the patients was 24 years 8.5 years. The operative time was 127.6 min 20.8 min. The median hospitalization was 4 days. There were no surgical complications, neurovascular injuries or mortality. Patients with a patent subclavian vein on the postoperative venogram (57 of 83 patients, 69%) were anticoagulated with warfarin for 3 months. In the remaining 27 patients with a persistent postoperative occlusion of the subclavian vein, 21 (21 of 83 patients, 24%) underwent angioplasty and were anticoagulated with warfarin for 3 months, and 6 (6 of 83, 7%) required stent placement to achieve complete vein patency. Patients who underwent stent placement received antiplatelet therapy in addition to warfarin anticoagulation for 3 months. At a median follow-up of 24 months, all patients had an open subclavian vein with a patency rate of 100%. CONCLUSIONS: The robotic transthoracic first-rib resection is feasible and allows for a minimally invasive resection of the first rib, while minimizing neurovascular complications.

KW - Minimally invasive surgery

KW - Paget-Schroetter syndrome

KW - Robotic surgery

KW - Thoracic outlet syndrome

UR - http://www.scopus.com/inward/record.url?scp=85062544908&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062544908&partnerID=8YFLogxK

U2 - 10.1093/ejcts/ezy275

DO - 10.1093/ejcts/ezy275

M3 - Article

VL - 55

SP - 434

EP - 439

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 3

ER -