{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:46:14Z","timestamp":1790109974948,"version":"4.0.1"},"reference-count":27,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T00:00:00Z","timestamp":1617926400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vascular"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Venous thoracic outlet syndrome (vTOS) is caused by external compression of the subclavian vein at the costoclavicular junction. It can be subdivided in McCleery Syndrome and Paget-Schroetter Syndrome (PSS). To improve the venous outflow of the arm and to prevent recurrent thrombosis, first rib resection with venolysis of the subclavian vein can be performed. Open transaxillary, supraclavicular, infraclavicular or combined paraclavicular approaches are well known, but more recent robot-assisted techniques are introduced. We report our short- and long-term results of a minimal invasive transthoracic approach for resection of the anteromedial part of the first rib using the DaVinci surgical robot, performed through three trocars.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed all patients with vTOS who were scheduled to undergo robot-assisted transthoracic first rib resection in the period July 2012 to May 2016. Outcomes were: technical success, operation time, blood loss, hospital stay, 30-day complications and patency. Functional outcomes were assessed using the \u201cDisability of the Arm, Shoulder and Hand\u201d (DASH) questionnaire.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifteen patients (8 male, 7 female; mean age 32.9\u2009years, range 20\u201354\u2009years) underwent robot-assisted transthoracic first rib resection. Conversion to transaxillary resection was necessary in three patients. Average operation time was 147.9\u2009min (range 88\u2013320\u2009min) with a mean blood loss of 79.5\u2009cc (range 10\u2013550 cc). Mean hospital stay was 3.5\u2009days (range 2\u20139). In three patients, complications were reported (Clavien-Dindo grade 2\u20133a). Patency was 91% at 15.5\u2009months\u2019 follow-up. DASH scores at one and three\u2009years showed excellent functional outcomes (7.1 (SD= 6.9, range 0\u201320.8) and 6.0 (SD= 6.4, range 0\u201325)) and are comparable to the scores of the normative general population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Robot-assisted transthoracic first rib resection with only three trocars is a feasible minimal invasive approach for first rib resection in the management of vTOS. This technique enables the surgeon to perform venolysis under direct 3D vision with good patency and long-term functional outcome. Studies with larger cohort size are needed to compare the outcomes of this robot-assisted technique with other more established approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1708538121997332","type":"journal-article","created":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T03:49:38Z","timestamp":1617940178000},"page":"217-224","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Robot-assisted transthoracic first rib resection for venous thoracic outlet syndrome"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8841-3093","authenticated-orcid":false,"given":"Frank","family":"Hoexum","sequence":"first","affiliation":[{"name":"Cardiovascular Sciences, Department of Vascular Surgery, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Jongkind","sequence":"additional","affiliation":[{"name":"Cardiovascular Sciences, Department of Vascular Surgery, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans ME","family":"Coveliers","sequence":"additional","affiliation":[{"name":"General District Hospital, Aalst, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kak K","family":"Yeung","sequence":"additional","affiliation":[{"name":"Cardiovascular Sciences, Department of Vascular Surgery, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem","family":"Wisselink","sequence":"additional","affiliation":[{"name":"Cardiovascular Sciences, Department of Vascular Surgery, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,4,9]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/1538574413512380"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9279"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X14568704"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1024\/0301-1526\/a000186"},{"key":"e_1_3_2_6_2","first-page":"255","article-title":"Are we managing primary upper limb deep venous thrombosis aggressively enough in the district?","volume":"24","author":"Fassiadis N","year":"2005","unstructured":"Fassiadis N, Roidl M, South M. Are we managing primary upper limb deep venous thrombosis aggressively enough in the district? Int Angiol 2005; 24: 255\u2013257.","journal-title":"Int Angiol"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2006.02.005"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1302451"},{"key":"e_1_3_2_9_2","first-page":"842","article-title":"Challenges in the treatment of thoracic outlet syndrome","volume":"39","author":"Thompson RW.","year":"2012","unstructured":"Thompson RW. Challenges in the treatment of thoracic outlet syndrome. Tex Heart Inst J 2012; 39: 842\u2013843.","journal-title":"Tex Heart Inst J"},{"key":"e_1_3_2_10_2","first-page":"599","article-title":"Severe injuries resulting from operations for thoracic outlet syndrome: can they be avoided?","volume":"32","author":"Melli\u00e8re D","year":"1991","unstructured":"Melli\u00e8re D, Becquemin JP, Etienne G, et al. Severe injuries resulting from operations for thoracic outlet syndrome: can they be avoided? J Cardiovasc Surg 1991; 32: 599\u2013603.","journal-title":"J Cardiovasc Surg"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0712(03)00084-2"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1258\/rsmvasc.13.6.327"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/imi.0b013e3182542ab3"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-018-4636-4"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezy275"},{"key":"e_1_3_2_16_2","first-page":"12","article-title":"Robotic First Rib Resection for Thoracic Outlet Syndrome","volume":"36","author":"Gharagozloo F","year":"2019","unstructured":"Gharagozloo F, Meyer M, Tempesta B, et al. Robotic First Rib Resection for Thoracic Outlet Syndrome. Surg Technol Int 2019; 36: 12 Dec sti36\/1228. 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Long-term results of local thrombolysis followed by first rib resection: an encouraging clinical experience in treatment of subclavian vein thrombosis. 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