Supraclavicular resection of the first rib for thoracic outlet syndrome.

The experience with supraclavicular transcervical first rib resection (or cervical rib resection) and total scalenotomy reported herein shows this to be a safe and effective treatment for patients with the thoracic outlet syndrome. We recommend this method as a satisfactory anatomic approach for the correction of this condition. Its advantages are as follows: anatomic structures may be visualized fully by both the surgeon and the assistant; complex or recurrent thoracic outlet problems may be dealt with directly; additional procedures (such as vascular graft, neurolysis, neck exploration, sympathectomy and cervical rib resection) may be performed; the procedure can be done in 90 minutes or less; neither the patient nor the assistant is obliged to assume an awkward or strained position and consequently the likelihood of intraoperative iatrogenic injury is reduced; and neither the period of hospitalization nor the period of immobility is longer than with the other operative techniques currently used for this condition.