Commentary on ‘Totally Endoscopic (VATS) First Rib Resection for Thoracic Outlet Syndrome’

George et al. presented an innovative approach with excellent results in a series of 10 patients treated with a complete thoracoscopic first rib resection for thoracic outlet syndrome (TOS) (1). Their video assisted thoracoscopic approach resulted in a complete resolution of symptoms in all patients after a follow-up of 6 months without major complications. Main advantages of the technique described are the superior visualization due to the magnified video-assisted thoracoscopic view, and perfect illumination by the scope allowing complete resection of the first rib. Theoretically this might improve results and reduce recurrence rates because presence of a long posterior first rib stump was found to be a strong predictor of poor outcome and residual complaints (2).