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A transaxillary approach for the first rib resection and neurovascular decompression were undertaken under magnified visualization. Endoscopic classification of neurovascular bundle (NVB) patterns and interscalene distance (ISD) between anterior and middle scalene muscles were evaluated intraoperatively. We assessed the Roos and DASH scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We reviewed 131 cases of TOS (48 women and 83 men; mean age 26.2 years; range 12 to 57). Roos classification revealed 80.2% excellent or good results. DASH scores improved significantly from 40.7 \u00b1 20.0 to 15.7 \u00b1 19.6 (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001). The complication rate was low (5.3%), with 4 pneumothorax and 3 other complications. Intraoperative NVB classification revealed 30 cases of parallel type, in which the artery and nerve travel in parallel; 69 oblique types, and 30 vertical types, in which the nerve was completely behind the middle scalene muscle or abnormal band. The ISD was narrower (5.4 \u00b1 3.6 mm) than in previous cadaveric studies. The ISD in the parallel patterns was wider than that in the vertical patterns. In the satisfactory group, we found a significantly larger number of men, younger patients, athletes, and patients with a lower preoperative DASH score.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An endoscopic\u2010assisted transaxillary approach for first rib resection in TOS provides an excellent magnified visualization, safely allowing sufficient decompression of the neurovascular bundle and satisfactory surgical outcomes. Younger male athletes with TOS may be better candidates for this procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>IV, therapeutic case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.asmr.2020.08.019","type":"journal-article","created":{"date-parts":[[2021,1,29]],"date-time":"2021-01-29T20:13:50Z","timestamp":1611951230000},"update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":15,"title":["Endoscopic\u2010Assisted Transaxillary Approach for First Rib Resection in Thoracic Outlet Syndrome"],"prefix":"10.1002","volume":"3","author":[{"given":"Kozo","family":"Furushima","sequence":"first","affiliation":[{"name":"Keiyu Orthopaedic Hospital Tatebayashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadanao","family":"Funakoshi","sequence":"additional","affiliation":[{"name":"Keiyu Orthopaedic Hospital Tatebayashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Kusano","sequence":"additional","affiliation":[{"name":"Keiyu Orthopaedic Hospital Tatebayashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azusa","family":"Miyamoto","sequence":"additional","affiliation":[{"name":"Keiyu Orthopaedic Hospital Tatebayashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Keiyu Orthopaedic Hospital Tatebayashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukio","family":"Horiuchi","sequence":"additional","affiliation":[{"name":"Keiyu Orthopaedic Hospital Tatebayashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyasu","family":"Itoh","sequence":"additional","affiliation":[{"name":"Keiyu Orthopaedic Hospital Tatebayashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,30]]},"reference":[{"key":"e_1_2_2_2_2","first-page":"66","article-title":"Thoracic outlet syndrome. 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Published by Elsevier Inc. on behalf of the Arthroscopy Association of North America.","name":"copyright","label":"Copyright"}]}}