Robotic First Rib Resection Utilizing the Da Vinci Xi System

Thoracic outlet syndrome (TOS) is a relatively rare but debilitating disease primarily effecting young adults. Surgical resection of the first rib is an effective treatment for clinically apparent TOS. The Xi robotic platform allows for superior visualization of the first rib during resection as well as continuous and improved visualization of the neuro-vasculature without the need for potentially harmful retraction of these vital structures. Fine dissection is easily accomplished with the robotic instruments with greater ease than that experienced with nonrobotic thoracoscopic approaches. Lysis of scar tissue restricting the neurovascular structures is possible with the robotic platform whereas this is not typically feasible with most open and standard thoracoscopic approaches. The objective of this article is to highlight these advantages while detailing the key operative steps of a robotic first rib resection using the Xi system.