{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T13:06:51Z","timestamp":1776085611101,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T00:00:00Z","timestamp":1775952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This study aimed to evaluate postoperative outcomes following transaxillary first rib resection with concomitant anterior scalenotomy (Roos procedure) for Thoracic Outlet Syndrome, using an ambispective design with a standardized two-year multimodal follow-up in a prospectively observed subgroup. Materials and Methods: This ambispective observational cohort study included 32 patients (87.5% women; mean age, 33.8 years) who underwent transaxillary first rib resection with anterior scalenotomy for Thoracic Outlet Syndrome. Of these, seven patients comprised the retrospective cohort, having undergone surgery between 2017 and 2019, while the remaining 25 patients were enrolled prospectively and underwent surgery from 2020 onwards. Patients were classified as having neurogenic, vascular (arterial or venous), or mixed Thoracic Outlet Syndrome. Retrospective data were obtained from medical records, while prospectively treated patients were followed according to a predefined postoperative protocol. Longitudinal changes in clinical outcomes were analyzed using mixed linear and logistic regression models. Results: All analyzed symptoms improved after surgery (p &lt; 0.05), with a significant reduction in upper limb edema over time (OR = 0.44, p = 0.002). The prevalence of positive provocative tests decreased notably across all maneuvers postoperatively. Pathological color duplex ultrasound findings of the upper limb vessels resolved almost completely during follow-up. Patient-reported outcome measures (CBSQ, DASH, and BPI) demonstrated meaningful postoperative improvement with sustained benefits over time. Electrophysiological evaluation revealed notable improvement in median sensory and motor nerve conduction parameters. Conclusions: Transaxillary first rib resection with anterior scalenotomy appears to improve clinical, functional, and objective outcomes in patients with Thoracic Outlet Syndrome; however, findings should be interpreted with caution due to the ambispective design, small sample size, and cohort heterogeneity, and require confirmation in larger prospective studies.<\/jats:p>","DOI":"10.3390\/medicina62040735","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T11:38:26Z","timestamp":1776080306000},"page":"735","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative Outcomes of Transaxillary First Rib Resection with Anterior Scalenotomy for Thoracic Outlet Syndrome: An Ambispective Multimodal Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5149-7780","authenticated-orcid":false,"given":"Thrasyvoulos","family":"Michos","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, \u201cAttikon\u201d University Hospital, National and Kapodistrian University of Athens, 12 461 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6276-8937","authenticated-orcid":false,"given":"Anastasia","family":"Roumpaki","sequence":"additional","affiliation":[{"name":"Liver Outpatient Unit, 3rd Internal Medicine Department, Evangelismos General Hospital, 106 76 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8354-4641","authenticated-orcid":false,"given":"Emmanouil I.","family":"Kapetanakis","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, \u201cAttikon\u201d University Hospital, National and Kapodistrian University of Athens, 12 461 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petros","family":"Michos","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, General Hospital of Attica \u201c\u039a.A.\u03a4\u201d, 145 61 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioannis","family":"Gakidis","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, General Hospital of Attica \u201c\u039a.A.\u03a4\u201d, 145 61 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos","family":"Chantziantoniou","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, General Hospital of Attica \u201c\u039a.A.\u03a4\u201d, 145 61 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aikaterini","family":"Kotroni","sequence":"additional","affiliation":[{"name":"Department of Physical Rehabilitation Medicine, General Hospital of Attica \u201c\u039a.A.\u03a4\u201d, 145 61 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioanna","family":"Vlachou","sequence":"additional","affiliation":[{"name":"Radiology Department, General Hospital of Attica \u201c\u039a.A.\u03a4\u201d, 145 61 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asterios","family":"Kanakis","sequence":"additional","affiliation":[{"name":"Department of Physical Rehabilitation Medicine, General Hospital of Attica \u201c\u039a.A.\u03a4\u201d, 145 61 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicenzo","family":"Castilletti","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, 401 Military Hospital of Athens, 115 25 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3242-9066","authenticated-orcid":false,"given":"Chara","family":"Tzavara","sequence":"additional","affiliation":[{"name":"Center of Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, 11 527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5710-7314","authenticated-orcid":false,"given":"George","family":"Babis","sequence":"additional","affiliation":[{"name":"2nd Department of Orthopaedics, Konstantopouleio Hospital, National and Kapodistrian University of Athens, 10 559 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Periklis","family":"Tomos","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, \u201cAttikon\u201d University Hospital, National and Kapodistrian University of Athens, 12 461 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spiros","family":"Pneumaticos","sequence":"additional","affiliation":[{"name":"3rd Department of Orthopaedics, General Hospital of Attica \u201c\u039a.A.\u03a4\u201d, National and Kapodistrian University of Athens, 145 61 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Povlsen, S., and Povlsen, B. 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