Augmented reality-assisted infraclavicular first rib resection for arterial and venous thoracic outlet syndrome: a case series.

Background: The infraclavicular approach is a surgical approach for vascular thoracic outlet syndrome (TOS). However, difficulty in accessing the posterior aspect of the first rib may cause insufficient decompression. To address this problem, we used augmented reality (AR) technology to intraoperatively visualize and determine the extent of rib resection. This study aimed to introduce AR-assisted infraclavicular first rib resection for arterial or venous TOS and report its clinical outcomes.

Methods: AR-assisted rib resection was introduced in our unit in 2022. Using an infraclavicular approach, we performed first rib resection and scalenectomy with the assistance of endoscopy. We compared the edge of the intraoperatively resected rib with the resection area of the preoperative simulation displayed in the AR to determine the extent of the resection.

Results: Six patients who underwent AR-assisted rib resection for arterial or venous TOS had excellent or good Derkash scores at 1 year postoperatively. Postoperative angiography revealed no subclavian vessel stenosis.

Conclusions: AR technology enables intraoperative three-dimensional assessment of the location of major vessels and the extent of resection, which may contribute to improved outcomes.