Port-access first-rib resection.

We have developed a thoracoscopic first rib resection technique for treatment of thoracic outlet syndrome (TOS), employing new instruments designed for endoscopic surgery. A 49-year-old man with Paget-Schroetter syndrome was treated bilaterally, and a 25-year-old woman with neurologic symptoms was treated on the right side by thoracoscopic approach via three ports. Harmonic scalpel, endoscopic elevators, rongeurs, and an endoscopic drill were used. In two patients, approximately 80% of the first rib overlying the subclavian vessels and brachial plexus was successfully removed by this technique. We conclude that port-access first-rib resection is feasible and reproducible using the new instruments described.