Thoracic outlet surgery is a procedure to relieve compression of the nerves, arteries, or veins in the thoracic outlet, which is the space between the lower neck and upper chest. This surgery is typically considered when nonsurgical treatments like physical therapy and medication have not alleviated symptoms of thoracic outlet syndrome (TOS). The surgery may involve:
- Removing part or all of the first rib (first rib resection) to widen the thoracic outlet space and reduce compression.
- Removing or severing the scalene muscles that pass through the thoracic outlet which may contribute to compression (scalenectomy or scalenotomy).
- Removing scar tissue that compresses adjacent nerves, arteries, veins, or muscles.
- Sometimes repairing damaged blood vessels if arterial or venous compression has caused damage.
There are different surgical approaches, including:
- Robotic-assisted first rib resection with small incisions and superior visualization.
- Conventional rib resection through an incision above or below the clavicle.
- Transaxillary approach with incision in the armpit area to access the first rib.
- Supraclavicular approach with incision under the neck to expose nerves and vessels.
- Intraclavicular approach with incision under the collarbone for extensive vein repair.
Recovery usually involves a short hospital stay, with return to normal activities within days to weeks. Surgery aims to provide definitive relief of symptoms caused by nerve and blood vessel compression in the thoracic outlet. The procedure carries risks such as nerve injury and partial symptom relief, but it is tailored by surgeons based on the type of thoracic outlet syndrome (neurogenic, venous, arterial) and the patient’s specific anatomy and symptoms.
