We believe that we are on the cusp of one of the most exciting innovations in thoracic outlet surgery. A number of pioneering specialists are applying modern robotic surgery techniques to the challenges of thoracic outlet syndrome.
The Da Vinci Surgical System provides capabilities that no human hand can achieve. The system utilizes tiny laparoscopes, so the surgeon can see within tiny areas of the human body without requiring a large incision. The system also includes tools of various sizes, some of which are far smaller than a surgeon’s fingers. Not only can these tools reach areas that are inaccessible to the human hand, but they provide a range of motion no human can accomplish. Finally, the computer-assisted robot enables the surgeon with amazing precision and control.
Surgeons who are experienced with robotic surgery have found considerable success in shortening operative time, minimizing surgical complications, and improving outcomes, in addition to shortened recovery times.
Several recognized centers are pursuing the use of these tools in thoracic outlet syndrome:
Global Robotics Institute
Thoracic Robotic Surgery at UCLA
George Washington University Hospital
Yale Thoracic Surgery
We have been privileged to hold many discussions with Dr. Farid Gharagozloo at the Global Robotics Institute. Dr. Gharagozloo is a pioneer in the use of robotic surgery of the thoracic outlet. We have been able to observe this surgery, and the procedure is eye-opening. Through a radical approach from beneath the first rib, Dr. Gharagozloo was able to remove nearly all of the rib. His technique protected the brachial plexus and phrenic nerve, yet completely mobilized the floor of the thoracic outlet. This results in an excellent decompression, allowing the brachial plexus and subclavian artery and vein to flow freely through the thoracic outlet.
Dr. Gharagozloo believes that our old concepts of thoracic outlet syndrome should be considered in a new light. Specifically, compression of blood vessels in the thoracic outlet, even in the absence of aneurysm or blood clot, causes persistent, low-grade swelling and reduction in oxygen to the soft tissues. In combination with relatively milder compression or tension of the brachial plexus, symptoms can result. Here is an excellent video introducing Dr. Gharagozloo’s ideas and technique. We are happy to work with Dr. Gharagozloo on imaging these patients, as well as moving the field of thoracic outlet syndrome forward with new concepts and understanding.