Robotic first-rib resection
Relieving compression. Restoring arm function.
Arm pain, tingling or swelling can interfere with work, sleep and exercise. At Merrimack Thoracic & Esophageal Surgery, Dr. Paresh Mane evaluates thoracic outlet syndrome and offers robotic first-rib resection for selected patients. The starting point is a clear diagnosis and a plan matched to your symptoms.
Discuss your treatment optionsWhat is thoracic outlet syndrome?
Thoracic outlet syndrome (TOS) occurs when nerves or blood vessels are compressed as they travel from the neck toward the arm. The space near the collarbone and first rib is particularly important. Symptoms depend on the structure affected.
| Type | What patients may notice |
|---|---|
| Neurogenic TOS Nerve compression | Pain in the neck, shoulder or arm; tingling, numbness, weakness or fatigue with arm use. This is the most common form. |
| Venous TOS Vein compression | Arm swelling, heaviness, a blue color or prominent veins. A clot may form in the vein draining the arm. |
| Arterial TOS Artery compression | A cold or pale hand, arm pain or reduced circulation. The artery may become damaged or develop an aneurysm. |
An extra cervical rib, unusual muscles or bands of tissue, prior injury and repetitive overhead activity can contribute. [1]
Getting the diagnosis right
TOS can resemble problems in the neck, shoulder or other arm nerves. Assessment combines your history, examination and selected tests; a symptom-provoking maneuver alone is not enough to plan surgery.
- Examination: arm function, sensation, strength, circulation and positions that trigger symptoms.
- Imaging: X-rays for bony abnormalities; ultrasound and sometimes CT or MRI to assess blood vessels and surrounding anatomy.
- Nerve testing: EMG or nerve-conduction studies when needed to assess nerve injury or investigate other causes.
- Selected injections: an anesthetic muscle injection may help clarify the source of symptoms and guide treatment. [4]
When is surgery considered?
For neurogenic TOS, treatment usually begins with targeted physical therapy, activity changes and symptom management. Surgery may be appropriate when disabling symptoms persist despite an adequate nonsurgical program, or when concerning neurological findings call for earlier specialist assessment.
For venous or arterial TOS, the plan also addresses circulation. Clots or damaged vessels may require blood-thinning medication, clot treatment or vessel repair alongside decompression. These patients should not automatically follow the same therapy-first pathway. [3]
A minimally invasive surgical option
Robotic surgery for thoracic outlet syndrome
Robotic first-rib resection creates more room for compressed nerves or blood vessels by removing the part of the first rib contributing to narrowing. The surgeon may also release muscles or other compressing tissue as part of the decompression. [2]
The surgeon controls the instruments throughout the operation from a console. A camera and instruments are introduced through small incisions. The robot translates the surgeon's movements; it does not operate independently. [5]
Magnified 3D vision
A detailed view helps the surgeon work in a confined space around the rib and nearby structures.
Controlled instrument movement
Articulating instruments give the surgeon flexibility and control during delicate dissection.
Small-incision access
This approach can limit incision size and tissue disruption. Recovery still depends on the operation and the individual patient. [5]
Is robotics right for every patient?
No. The approach must fit the site of compression and any need for nerve or blood-vessel reconstruction. Incisions above or below the collarbone, an axillary approach or other techniques may be more appropriate. Dr. Mane will explain the proposed operation and alternatives. [4]
Recovery and risks
Plan for an individual recovery. The published 17-patient robotic series reported an average hospital stay of about two days. This is a study result, not a discharge promise; your stay depends on pain control, the extent of surgery and any additional vascular treatment. [6]
Rehabilitation and activity changes remain important. Your team will guide shoulder movement, lifting and return to work or sport. [3]
Risks include nerve injury and incomplete or recurrent symptoms. [4] Robotic surgery also carries surgical risks such as infection; small incisions do not eliminate complications. [5] Ask about bleeding, blood-vessel or lung injury, persistent pain, and the possibility of changing to an open approach as part of your consent discussion.
Independent, surgeon-led care
Discuss TOS treatment with Dr. Mane
Contact Merrimack Thoracic & Esophageal Surgery for an evaluation or second opinion in the Merrimack Valley and Southern New Hampshire, including discussion of robotic first-rib resection.
Bring prior imaging, nerve-test results, physical-therapy records and details of any injections or previous surgery. We will discuss what may be causing your symptoms, whether further testing is needed and which treatment approach fits your situation.
Sources and further reading
Original patient information based on specialist guidance and published research. Sources checked September 12, 2026. Your individual assessment determines the treatment plan.
- Johns Hopkins Medicine: Thoracic outlet syndrome
- Reyes et al. Robotic First Rib Resection in Thoracic Outlet Syndrome: A Systematic Review of Current Literature (2023). PubMed abstract.
- Cleveland Clinic: TOS symptoms and treatment
- Mayo Clinic: TOS diagnosis and treatment
- Mayo Clinic: Robotic surgery
- Pupovac et al. Robotic-Assisted First Rib Resection: Our Experience and Review of the Literature (2020)