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Julie A Freischlag - One of the best experts on this subject based on the ideXlab platform.
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coexistence of arterial compression in patients with neurogenic thoracic outlet syndrome
JAMA Surgery, 2014Co-Authors: Kendall C Likes, Danielle H Rochlin, Diana Call, Julie A FreischlagAbstract:Importance Patients with neurogenic thoracic outlet syndrome (NTOS) may have signs and symptoms of arterial compromise without thrombosis or aneurysm. Objective To evaluate these patients’ presentation, duration of signs and symptoms, and outcomes of immediate surgical operation. Design, Setting, and Participants Demographic and clinical data for patients with NTOS and signs and symptoms of arterial compromise without arterial thrombosis or aneurysm were extracted from a prospectively maintained, institutional review board–approved database and patient medical records between May 22, 2003, and October 16, 2012, in the Johns Hopkins Medical Institutions’ Department of Vascular and Endovascular Surgery. Interventions All patients received immediate first Rib Resection and scalenectomy (FRRS) (n = 15), cervical Rib Resection and FRRS (n = 6), or FRRS and second Rib Resection due to fusion (n = 1). Further physical therapy or anterior scalene block was not considered owing to arterial compression. Main Outcomes and Measures Surgical intervention relieved arterial and neurogenic symptoms, and abnormal duplex velocities returned to normal in adduction. Results Twenty-two patients (13 women and 9 men; mean age, 25 years [range, 12-41 years]) presented with the following signs and symptoms a mean of 37 months (range, 1-144 months) after developing symptoms of NTOS: arm discoloration (n = 15), infraclavicular bruit with arm abduction (n = 9), more than 50% change in subclavian artery velocity in abduction by duplex scan (n = 12), cervical Rib (n = 6), abnormal first Rib (n = 3), and/or history of embolization (n = 2). In addition, 2 patients had venous thrombosis. The mean follow-up time was 11 months (range, 1-34 months), and all patient outcomes improved in the postoperative period. Conclusions and Relevance Arterial compression can coexist with NTOS and can be elucidated in most patients by medical record review and physical examination, along with confirmation by a duplex scan. Those with evidence of arterial compression and for whom physical therapy has failed should receive surgery to alleviate their symptoms. Prompt surgical intervention affords good outcomes in these patients. Outcomes for patients with NTOS and arterial compression following immediate surgical intervention were previously unknown.
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bilateral first Rib Resection and scalenectomy is effective for treatment of thoracic outlet syndrome
Journal of Vascular Surgery, 2014Co-Authors: Danielle H Rochlin, Kendall C Likes, Megan S Orlando, Carly Jacobs, Julie A FreischlagAbstract:Objective Because of the small numbers of thoracic outlet syndrome (TOS) patients treated with bilateral first Rib Resection and scalenectomy (FRRS), this patient subset has not been well studied. We examined a large cohort of TOS patients who underwent bilateral FRRS to evaluate patient characteristics and outcomes. Methods Patients treated with bilateral FRRS at Johns Hopkins Medical Institutions from 2003 to 2012 were identified by review of a prospectively maintained database. Statistical analysis compared patients with unilateral and bilateral FRRS and bilateral patients with different TOS indications. Results Fifty-three patients underwent bilateral FRRS with a mean follow-up of 11.4 months. Average time between operations was 17.0 months (range, 5.1-59.8 months). Compared with 408 unilateral FRRS patients, bilateral patients were younger (30 vs 35 years; P = .012), with no significant difference in gender. Among patients with dual-sided FRRS, 25 (47%) had bilateral neurogenic symptoms, 2 (4%) had bilateral arterial symptoms, and 26 (49%) had venous symptoms with the first side due to intermittent compression in 5 (second side: four, intermittent compression; one, neurogenic) and effort thrombosis in 21 (second side: 9, effort thrombosis; 8, intermittent compression; 4, neurogenic). Ten patients had prophylactic FRRS to prevent contralateral venous or arterial thrombosis, and eight had cervical Ribs. Compared with neurogenic patients, venous patients were younger (25 vs 35 years; P Conclusions Bilateral FRRS is an effective method for treatment of TOS. Venous bilateral patients more often are younger, are competitive athletes, and require close postoperative monitoring for recurrent stenosis and thrombosis.
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limited venoplasty and anticoagulation affords excellent results after first Rib Resection and scalenectomy for subacute paget schroetter syndrome
Journal of vascular surgery. Venous and lymphatic disorders, 2014Co-Authors: Christopher J Abularrage, Danielle H Rochlin, Ying Wei Lum, Shalini Selvarajah, Julie A FreischlagAbstract:Objective We have previously demonstrated excellent mid-term patency rates following routine venography after first Rib Resection and scalenectomy (FRRS) for subacute Paget-Schroetter syndrome. The goal of this study was to assess the long-term outcomes of this technique. Methods Retrospective analysis of a prospectively collected database was performed. Patients underwent routine venography 2 weeks post-FRRS. Warfarin was discontinued in those with patent veins. Patients with stenotic or occluded veins underwent attempted venoplasty with balloon diameters approximating the size of the anatomically normal vein. Patients with successful venoplasty or chronically occluded veins unable to be dilated were continued on warfarin up to 6 months. Follow-up duplex ultrasound dictated cessation of anticoagulation. Kaplan-Meier analysis was performed for primary, primary-assisted, and secondary patency. Results A total of 159 patients underwent FRRS and postoperative venography with a median follow-up of 13.8 months. One patient was lost to follow-up. The median time to FRRS after the initial onset of symptoms was 4.1 months. At the time of venography, there were 42 patent, 72 stenotic, and 44 occluded veins. Of the 44 occlusions, 25 underwent venoplasty, and 19 could not be crossed. In the entire group, restenosis occurred in seven patients and reocclusion in seven. At last follow-up, six patients remained occluded. Eighteen-month primary patency of venoplasty was 95.4% ± 2.6% in the stenotic group and 75.6% ± 8.7% in the occluded group. Eighteen-month primary-assisted patency of venoplasty was 98.3% ± 1.7% in the stenotic group and 96.0% ± 3.9% in the occluded group. Overall secondary patency at 3 years was 100% in the patent group, 98.4% ± 1.6% in the stenotic group, and 92.9% ± 3.9% in the occluded group. Conclusions Long-term venous patency rates after limited venoplasty and anticoagulation following FRRS are excellent. Furthermore, prolonged anticoagulation for occlusions that could not be crossed or in those who reocclude after venoplasty results in recanalization and delayed patency. These results argue against the need for stenting or open venous reconstruction and serve as a benchmark for the care of patients with subacute Paget-Schroetter syndrome.
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quality of life scores in neurogenic thoracic outlet syndrome patients undergoing first Rib Resection and scalenectomy
Journal of Vascular Surgery, 2013Co-Authors: Danielle H Rochlin, Marta M Gilson, Kendall C Likes, Emma Graf, Nancy Ford, Paul J Christo, Julie A FreischlagAbstract:Objective First Rib Resection and scalenectomy (FRRS) has been shown to improve short-term quality of life (QOL) in the treatment of neurogenic thoracic outlet syndrome (NTOS). Long-term benefits are not well studied but are believed to decrease over time. Our objective was to evaluate long-term NTOS outcomes using validated QOL instruments. Methods We identified 162 NTOS patients aged ≥18 years treated by FRRS from 2003 to 2010 after they had not responded to conservative management. The patients were mailed three surveys to assess QOL (Short-Form 12 [SF-12], Brief Pain Inventory [BPI], and Cervical Brachial Symptom Questionnaire [CBSQ]), with five total outcomes measures including the SF-12 Physical Component Score (PCS), SF-12 Mental Component Score (MCS), BPI severity, BPI interference, and CBSQ score. Demographic and clinical data were extracted from patient records. Each FRRS was categorized based on postoperative clinical assessment as successful, failed, or leading to recurrent symptoms. Results Survey yield was 53.7% (n = 87) with mean follow-up of 44.7 months (range, 12.4-91.9 months). There was no significant difference in QOL scores associated with long-term compared with short-term follow-up. Significantly poorer scores on all instruments were associated with comorbid chronic pain syndromes, opioid use, and unfavorable clinical assessment ( P P P P P P Conclusions The QOL after FRRS shows no significant difference with longer follow-up. Clinical assessment reflects patient-reported outcomes and can gauge postoperative improvement. Patient factors, particularly comorbidities and opioid use, are more predictive of long-term QOL than is preoperative scalene block and should also be considered when selecting patients for surgical intervention.
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The significance of cervical Ribs in thoracic outlet syndrome
Journal of vascular surgery, 2013Co-Authors: Kevin Chang, Kendall C Likes, Jasmine Demos, Kylie Davis, Julie A FreischlagAbstract:Objective The purpose of this study was to review our operative experience in patients with thoracic outlet syndrome (TOS) resulting from cervical Ribs causing clinical symptoms. Methods This study is a retrospective review of a prospectively acquired database of patients with TOS treated with first Rib Resection and scalenectomy with or without cervical Rib Resection at the Johns Hopkins Medical Institutions. Results Between October 2003 and June 2011, a total of 23 cervical Rib Resections were performed on 20 patients, three of whom had bilateral cervical Ribs resected during separate operations. Seven patients presented with subclavian artery thrombosis. Three of seven patients had subclavian artery aneurysms and underwent cervical Rib Resection through a supraclavicular approach to facilitate subclavian artery bypass. Five patients presented with an ischemic upper extremity without thrombosis and underwent transaxillary first Rib and cervical Rib Resection. Three patients presented with subclavian vein thrombosis; two of the three patients underwent balloon dilation 2 weeks postoperatively for stenosis. Additionally, five patients presented with neurogenic TOS evidenced by pain, numbness, and weakness without vascular compromise in the affected arm. Cervical Ribs with bony fusion to the first Rib were found in 17 of 23 cases (74%). Conclusions Cervical Ribs causing clinical symptoms are large and frequently fused to the first Rib, and can result in aneurysm formation or thrombosis. In our experience, both the cervical Rib and the first Rib must be removed to relieve arterial compression and can usually be done through a transaxillary approach. Only patients with aneurysms needing arterial reconstruction require Resection of the artery from a supraclavicular approach.
Kendall C Likes - One of the best experts on this subject based on the ideXlab platform.
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coexistence of arterial compression in patients with neurogenic thoracic outlet syndrome
JAMA Surgery, 2014Co-Authors: Kendall C Likes, Danielle H Rochlin, Diana Call, Julie A FreischlagAbstract:Importance Patients with neurogenic thoracic outlet syndrome (NTOS) may have signs and symptoms of arterial compromise without thrombosis or aneurysm. Objective To evaluate these patients’ presentation, duration of signs and symptoms, and outcomes of immediate surgical operation. Design, Setting, and Participants Demographic and clinical data for patients with NTOS and signs and symptoms of arterial compromise without arterial thrombosis or aneurysm were extracted from a prospectively maintained, institutional review board–approved database and patient medical records between May 22, 2003, and October 16, 2012, in the Johns Hopkins Medical Institutions’ Department of Vascular and Endovascular Surgery. Interventions All patients received immediate first Rib Resection and scalenectomy (FRRS) (n = 15), cervical Rib Resection and FRRS (n = 6), or FRRS and second Rib Resection due to fusion (n = 1). Further physical therapy or anterior scalene block was not considered owing to arterial compression. Main Outcomes and Measures Surgical intervention relieved arterial and neurogenic symptoms, and abnormal duplex velocities returned to normal in adduction. Results Twenty-two patients (13 women and 9 men; mean age, 25 years [range, 12-41 years]) presented with the following signs and symptoms a mean of 37 months (range, 1-144 months) after developing symptoms of NTOS: arm discoloration (n = 15), infraclavicular bruit with arm abduction (n = 9), more than 50% change in subclavian artery velocity in abduction by duplex scan (n = 12), cervical Rib (n = 6), abnormal first Rib (n = 3), and/or history of embolization (n = 2). In addition, 2 patients had venous thrombosis. The mean follow-up time was 11 months (range, 1-34 months), and all patient outcomes improved in the postoperative period. Conclusions and Relevance Arterial compression can coexist with NTOS and can be elucidated in most patients by medical record review and physical examination, along with confirmation by a duplex scan. Those with evidence of arterial compression and for whom physical therapy has failed should receive surgery to alleviate their symptoms. Prompt surgical intervention affords good outcomes in these patients. Outcomes for patients with NTOS and arterial compression following immediate surgical intervention were previously unknown.
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bilateral first Rib Resection and scalenectomy is effective for treatment of thoracic outlet syndrome
Journal of Vascular Surgery, 2014Co-Authors: Danielle H Rochlin, Kendall C Likes, Megan S Orlando, Carly Jacobs, Julie A FreischlagAbstract:Objective Because of the small numbers of thoracic outlet syndrome (TOS) patients treated with bilateral first Rib Resection and scalenectomy (FRRS), this patient subset has not been well studied. We examined a large cohort of TOS patients who underwent bilateral FRRS to evaluate patient characteristics and outcomes. Methods Patients treated with bilateral FRRS at Johns Hopkins Medical Institutions from 2003 to 2012 were identified by review of a prospectively maintained database. Statistical analysis compared patients with unilateral and bilateral FRRS and bilateral patients with different TOS indications. Results Fifty-three patients underwent bilateral FRRS with a mean follow-up of 11.4 months. Average time between operations was 17.0 months (range, 5.1-59.8 months). Compared with 408 unilateral FRRS patients, bilateral patients were younger (30 vs 35 years; P = .012), with no significant difference in gender. Among patients with dual-sided FRRS, 25 (47%) had bilateral neurogenic symptoms, 2 (4%) had bilateral arterial symptoms, and 26 (49%) had venous symptoms with the first side due to intermittent compression in 5 (second side: four, intermittent compression; one, neurogenic) and effort thrombosis in 21 (second side: 9, effort thrombosis; 8, intermittent compression; 4, neurogenic). Ten patients had prophylactic FRRS to prevent contralateral venous or arterial thrombosis, and eight had cervical Ribs. Compared with neurogenic patients, venous patients were younger (25 vs 35 years; P Conclusions Bilateral FRRS is an effective method for treatment of TOS. Venous bilateral patients more often are younger, are competitive athletes, and require close postoperative monitoring for recurrent stenosis and thrombosis.
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quality of life scores in neurogenic thoracic outlet syndrome patients undergoing first Rib Resection and scalenectomy
Journal of Vascular Surgery, 2013Co-Authors: Danielle H Rochlin, Marta M Gilson, Kendall C Likes, Emma Graf, Nancy Ford, Paul J Christo, Julie A FreischlagAbstract:Objective First Rib Resection and scalenectomy (FRRS) has been shown to improve short-term quality of life (QOL) in the treatment of neurogenic thoracic outlet syndrome (NTOS). Long-term benefits are not well studied but are believed to decrease over time. Our objective was to evaluate long-term NTOS outcomes using validated QOL instruments. Methods We identified 162 NTOS patients aged ≥18 years treated by FRRS from 2003 to 2010 after they had not responded to conservative management. The patients were mailed three surveys to assess QOL (Short-Form 12 [SF-12], Brief Pain Inventory [BPI], and Cervical Brachial Symptom Questionnaire [CBSQ]), with five total outcomes measures including the SF-12 Physical Component Score (PCS), SF-12 Mental Component Score (MCS), BPI severity, BPI interference, and CBSQ score. Demographic and clinical data were extracted from patient records. Each FRRS was categorized based on postoperative clinical assessment as successful, failed, or leading to recurrent symptoms. Results Survey yield was 53.7% (n = 87) with mean follow-up of 44.7 months (range, 12.4-91.9 months). There was no significant difference in QOL scores associated with long-term compared with short-term follow-up. Significantly poorer scores on all instruments were associated with comorbid chronic pain syndromes, opioid use, and unfavorable clinical assessment ( P P P P P P Conclusions The QOL after FRRS shows no significant difference with longer follow-up. Clinical assessment reflects patient-reported outcomes and can gauge postoperative improvement. Patient factors, particularly comorbidities and opioid use, are more predictive of long-term QOL than is preoperative scalene block and should also be considered when selecting patients for surgical intervention.
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The significance of cervical Ribs in thoracic outlet syndrome
Journal of vascular surgery, 2013Co-Authors: Kevin Chang, Kendall C Likes, Jasmine Demos, Kylie Davis, Julie A FreischlagAbstract:Objective The purpose of this study was to review our operative experience in patients with thoracic outlet syndrome (TOS) resulting from cervical Ribs causing clinical symptoms. Methods This study is a retrospective review of a prospectively acquired database of patients with TOS treated with first Rib Resection and scalenectomy with or without cervical Rib Resection at the Johns Hopkins Medical Institutions. Results Between October 2003 and June 2011, a total of 23 cervical Rib Resections were performed on 20 patients, three of whom had bilateral cervical Ribs resected during separate operations. Seven patients presented with subclavian artery thrombosis. Three of seven patients had subclavian artery aneurysms and underwent cervical Rib Resection through a supraclavicular approach to facilitate subclavian artery bypass. Five patients presented with an ischemic upper extremity without thrombosis and underwent transaxillary first Rib and cervical Rib Resection. Three patients presented with subclavian vein thrombosis; two of the three patients underwent balloon dilation 2 weeks postoperatively for stenosis. Additionally, five patients presented with neurogenic TOS evidenced by pain, numbness, and weakness without vascular compromise in the affected arm. Cervical Ribs with bony fusion to the first Rib were found in 17 of 23 cases (74%). Conclusions Cervical Ribs causing clinical symptoms are large and frequently fused to the first Rib, and can result in aneurysm formation or thrombosis. In our experience, both the cervical Rib and the first Rib must be removed to relieve arterial compression and can usually be done through a transaxillary approach. Only patients with aneurysms needing arterial reconstruction require Resection of the artery from a supraclavicular approach.
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routine venography following transaxillary first Rib Resection and scalenectomy frrs for chronic subclavian vein thrombosis ensures excellent outcomes and vein patency
Vascular and Endovascular Surgery, 2012Co-Authors: Kevin Chang, Kendall C Likes, Jasmine Demos, James H Black, Julie A FreischlagAbstract:To assess the role of postoperative venography in patients treated with first Rib Resection and scalenectomy (FRRS) for effort thrombosis, a retrospective review was done to evaluate long-term venous patency in 84 patients treated at the Johns Hopkins Medical Institutions. Patients undergo venography 2 weeks postoperatively. If there is >50% stenosis, the subclavian vein is dilated and the patient receives anticoagulation. If the vein is occluded, patients are maintained on anticoagulation. Of the 85 patients, 21 patients had patent veins, 47 patients had stenotic veins, and 16 patients had chronically occluded veins. In follow-up, symptomatic restenosis was seen in 3 patients and those veins were redilated. Two other patients had late occlusions at 23 and 63 months and received anticoagulation and redilatation, respectively. Using venography to guide postoperative management, 79 of 84 patients had patent veins many years postoperatively. Long-term patency, as seen by duplex scan, was achieved in nearly all patients using this protocol.
Kostas Papagiannopoulos - One of the best experts on this subject based on the ideXlab platform.
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totally endoscopic vats first Rib Resection for thoracic outlet syndrome
The Annals of Thoracic Surgery, 2017Co-Authors: Robert S. George, Richard Milton, Nilanjan Chaudhuri, Emmanuel Kefaloyannis, Kostas PapagiannopoulosAbstract:Background Thoracic outlet syndrome (TOS) causes neurologic symptoms in 95% of cases and vascular symptoms in 5% of cases. Surgical Resection is curative. Endoscopic-assisted transaxillary first Rib Resection has been previously reported. In this study we report a totally endoscopic video-assisted thoracoscopic surgery (VATS) approach using tailored endoscopic instruments. Methods Ten patients (8 women; average age, 32.3 ± 5.6 years) with TOS underwent VATS first Rib Resection following failure of symptom improvement with physiotherapy. Symptoms were: unilateral neurogenic (n = = 7), bilateral neurogenic (n = = 2), and bilateral arterial compression (n = = 1). Three standard VATS ports were utilized. The parietal pleura and periosteum overlying the first Rib were stripped avoiding injury to the neurovascular bundle. The Rib was transected with an endoscopic Rib cutter and resected completely in a piecemeal fashion using endoscopic bone nibblers. All periosteal remnants were trimmed releasing the neurovascular bundle completely. Results Patients were discharged within 72 hours following surgery. One patient had the contralateral side treated 18 months later and another patient is awaiting the second surgery. At follow-up, 9 patients had complete resolution of their main symptoms. One patient with neurogenic TOS developed mild functional and sensational loss of the non-dominant hand that improved within 8 months with physiotherapy. Conclusions VATS first Rib Resection for TOS provides, unlike the classic approaches, a superior, magnified, and well-illuminated view of the thoracic inlet. It allows good posterior trimming of the first Rib, release of brachial plexus, and an aesthetically pleasing result, especially in female patients.
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totally endoscopic vats first Rib Resection for thoracic outlet syndrome
The Annals of Thoracic Surgery, 2017Co-Authors: Robert S. George, Richard Milton, Nilanjan Chaudhuri, Emmanuel Kefaloyannis, Kostas PapagiannopoulosAbstract:Background Thoracic outlet syndrome (TOS) causes neurologic symptoms in 95% of cases and vascular symptoms in 5% of cases. Surgical Resection is curative. Endoscopic-assisted transaxillary first Rib Resection has been previously reported. In this study we report a totally endoscopic video-assisted thoracoscopic surgery (VATS) approach using tailored endoscopic instruments. Methods Ten patients (8 women; average age, 32.3 ± 5.6 years) with TOS underwent VATS first Rib Resection following failure of symptom improvement with physiotherapy. Symptoms were: unilateral neurogenic (n = = 7), bilateral neurogenic (n = = 2), and bilateral arterial compression (n = = 1). Three standard VATS ports were utilized. The parietal pleura and periosteum overlying the first Rib were stripped avoiding injury to the neurovascular bundle. The Rib was transected with an endoscopic Rib cutter and resected completely in a piecemeal fashion using endoscopic bone nibblers. All periosteal remnants were trimmed releasing the neurovascular bundle completely. Results Patients were discharged within 72 hours following surgery. One patient had the contralateral side treated 18 months later and another patient is awaiting the second surgery. At follow-up, 9 patients had complete resolution of their main symptoms. One patient with neurogenic TOS developed mild functional and sensational loss of the non-dominant hand that improved within 8 months with physiotherapy. Conclusions VATS first Rib Resection for TOS provides, unlike the classic approaches, a superior, magnified, and well-illuminated view of the thoracic inlet. It allows good posterior trimming of the first Rib, release of brachial plexus, and an aesthetically pleasing result, especially in female patients.
Bryan M Burt - One of the best experts on this subject based on the ideXlab platform.
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safety of robotic first Rib Resection for thoracic outlet syndrome
The Journal of Thoracic and Cardiovascular Surgery, 2021Co-Authors: Bryan M Burt, Nihanth Palivela, Davut Cekmecelioglu, Paul Paily, Bijan Najafi, Hyunsung Lee, Miguel MonteroAbstract:Abstract Objectives Robotic first Rib Resection (R-FRR) is an emerging approach in the field of thoracic outlet syndrome (TOS) that has technical advantages over traditional open approaches, including superior exposure of the first Rib and freedom from retracting neurovascular structures. We set out to define the safety of R-FRR and compare it with that of the conventional supraclavicular approach (SC-FRR). Methods We queried a prospectively maintained, single-surgeon, single-institution database for all FRR operations performed for neurogenic TOS and venous TOS. Preoperative, intraoperative, and complications were compared between approaches. Results Seventy-two R-FRRs and 51 SC-FRRs were performed in 66 and 50 patients, respectively. These groups were not significantly different in age, body mass index, sex, type of TOS, or preoperative use of opioids. Length of procedure and hospital stay were not different between groups. Postoperative inpatient self-reported pain (visual analog scale score 4.7 vs 5.2; P = .049) and administered morphine milligram equivalents (37.5 vs 81.1 MME, P Conclusions R-FRR provides outstanding exposure of the first Rib and eliminates retraction of the brachial plexus and its consequences.
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improvement of disability in neurogenic thoracic outlet syndrome by robotic first Rib Resection
The Annals of Thoracic Surgery, 2021Co-Authors: Nihanth Palivela, Paul Paily, Bijan Najafi, Hyunsung Lee, Miguel Montero, Hee Jin Jang, Bryan M BurtAbstract:ABSTRACT Background Robotic transthoracic first Rib Resection (R-FRR) has advantages over traditional approaches however its impact on post-operative nTOS outcomes is unknown. Our primary objective was to determine improvement of patient-reported outcome measures (PROMs) of pain and disability following R-FRR in neurogenic thoracic outlet syndrome (nTOS). Our secondary objective was to compare improvement of patient-reported pain between R-FRR and supraclavicular FRR (SC-FRR) in nTOS. Methods We queried a prospectively-maintained, single surgeon, single institution database for nTOS patients undergoing R-FRR or SC-FRR with available pre-operative and post-operative PROMs. PROMs included the Disability of the Arm, Hand, and Shoulder (DASH) questionnaire and Visual Analog Scale (VAS) for pain. Results Cohort 1 included 37 patients undergoing 40 R-FRRs and was comprised of 32 females, aged 36 years on average. Pre-operative VAS and DASH (6.0 and 64.2, respectively) improved significantly at the first (2.8 and 35.0, P Conclusions R-FRR results in significant improvement in disability and pain in nTOS and may have a greater impact on patient-reported pain than SC-FRR in the early postoperative period.
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transthoracic robotic first Rib Resection technique crystallized
The Annals of Thoracic Surgery, 2020Co-Authors: Bryan M Burt, Nihanth Palivela, Michael B GoodmanAbstract:The advantages of transthoracic robotic first Rib Resection are uncontested exposure of the anatomy of the thoracic outlet and freedom from any neurovascular retraction. The technique of robotic first Rib Resection is distilled here in a patient with neurogenic thoracic outlet syndrome.
Robert S. George - One of the best experts on this subject based on the ideXlab platform.
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Arterial Thoracic Outlet Syndrome Treated Successfully with Totally Endoscopic First Rib Resection
Hindawi Limited, 2017Co-Authors: Sofoklis Mitsos, Davide Patrini, Sara Velo, Achilleas Antonopoulos, Martin Hayward, Robert S. George, David Lawrence, Nikolaos PanagiotopoulosAbstract:Thoracic outlet syndrome (TOS) is a constellation of signs and symptoms caused by compression of the neurovascular structures in the thoracic outlet. TOS may be classified as either neurogenic TOS (NTOS) or vascular TOS: venous TOS (VTOS) or arterial TOS (ATOS), depending on the specific structure being affected. The basis for the surgical treatment of TOS is Resection of the first Rib, and it may be combined with scalenectomy or cervical Rib Resection. Herein, we descRibe a case of arterial thoracic outlet syndrome which was successfully treated with totally endoscopic video-assisted thoracoscopic surgery (VATS) first Rib Resection
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totally endoscopic vats first Rib Resection for thoracic outlet syndrome
The Annals of Thoracic Surgery, 2017Co-Authors: Robert S. George, Richard Milton, Nilanjan Chaudhuri, Emmanuel Kefaloyannis, Kostas PapagiannopoulosAbstract:Background Thoracic outlet syndrome (TOS) causes neurologic symptoms in 95% of cases and vascular symptoms in 5% of cases. Surgical Resection is curative. Endoscopic-assisted transaxillary first Rib Resection has been previously reported. In this study we report a totally endoscopic video-assisted thoracoscopic surgery (VATS) approach using tailored endoscopic instruments. Methods Ten patients (8 women; average age, 32.3 ± 5.6 years) with TOS underwent VATS first Rib Resection following failure of symptom improvement with physiotherapy. Symptoms were: unilateral neurogenic (n = = 7), bilateral neurogenic (n = = 2), and bilateral arterial compression (n = = 1). Three standard VATS ports were utilized. The parietal pleura and periosteum overlying the first Rib were stripped avoiding injury to the neurovascular bundle. The Rib was transected with an endoscopic Rib cutter and resected completely in a piecemeal fashion using endoscopic bone nibblers. All periosteal remnants were trimmed releasing the neurovascular bundle completely. Results Patients were discharged within 72 hours following surgery. One patient had the contralateral side treated 18 months later and another patient is awaiting the second surgery. At follow-up, 9 patients had complete resolution of their main symptoms. One patient with neurogenic TOS developed mild functional and sensational loss of the non-dominant hand that improved within 8 months with physiotherapy. Conclusions VATS first Rib Resection for TOS provides, unlike the classic approaches, a superior, magnified, and well-illuminated view of the thoracic inlet. It allows good posterior trimming of the first Rib, release of brachial plexus, and an aesthetically pleasing result, especially in female patients.
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totally endoscopic vats first Rib Resection for thoracic outlet syndrome
The Annals of Thoracic Surgery, 2017Co-Authors: Robert S. George, Richard Milton, Nilanjan Chaudhuri, Emmanuel Kefaloyannis, Kostas PapagiannopoulosAbstract:Background Thoracic outlet syndrome (TOS) causes neurologic symptoms in 95% of cases and vascular symptoms in 5% of cases. Surgical Resection is curative. Endoscopic-assisted transaxillary first Rib Resection has been previously reported. In this study we report a totally endoscopic video-assisted thoracoscopic surgery (VATS) approach using tailored endoscopic instruments. Methods Ten patients (8 women; average age, 32.3 ± 5.6 years) with TOS underwent VATS first Rib Resection following failure of symptom improvement with physiotherapy. Symptoms were: unilateral neurogenic (n = = 7), bilateral neurogenic (n = = 2), and bilateral arterial compression (n = = 1). Three standard VATS ports were utilized. The parietal pleura and periosteum overlying the first Rib were stripped avoiding injury to the neurovascular bundle. The Rib was transected with an endoscopic Rib cutter and resected completely in a piecemeal fashion using endoscopic bone nibblers. All periosteal remnants were trimmed releasing the neurovascular bundle completely. Results Patients were discharged within 72 hours following surgery. One patient had the contralateral side treated 18 months later and another patient is awaiting the second surgery. At follow-up, 9 patients had complete resolution of their main symptoms. One patient with neurogenic TOS developed mild functional and sensational loss of the non-dominant hand that improved within 8 months with physiotherapy. Conclusions VATS first Rib Resection for TOS provides, unlike the classic approaches, a superior, magnified, and well-illuminated view of the thoracic inlet. It allows good posterior trimming of the first Rib, release of brachial plexus, and an aesthetically pleasing result, especially in female patients.