Doctors at Cleveland Clinic Abu Dhabi (CCAD) have performed a pioneering robotic rib resection and venolysis procedure for venous thoracic outlet syndrome (VTOS), a rare condition affecting one to two individuals per 100,000.
The under-three-hour minimally invasive innovative robotic procedure was performed on a 22-year-old female patient at the hospital, which is part of the M42 network.
What is VTOS?
It is a condition characterised by the compression of the subclavian vein, which carries blood from the arm to the heart. It often goes undiagnosed or misdiagnosed. The condition often occurs in young, active individuals engaged in repetitive arm movements, such as swimmers, baseball players, cricket players, and those involved in cross-fit training or who have a job that requires repetitive motion in the arm and shoulder. It can also occur among women aged 20 to 50.
Innovative technique
Traditionally, the surgery is done through a large incision in the upper chest, which requires extended healing time and visible scarring. Using the robot, three one-centimetre incisions were made on the patient’s back to remove the part of the first rib that was causing vein compression. This resulted in no visible scars and was virtually pain-free for the patient, without compromising the clinical outcome. The patient was discharged after spending two nights in the hospital.
Causes and symptoms
“A person is more likely to get VTOS if they have a naturally narrow passageway for the subclavian vein. Research shows that if a patient receives treatment within the first 14 days of symptoms appearing, the chances of a successful outcome significantly increase,” Dr Houssam Younes, staff physician in the Heart, Vascular, and Thoracic Institute at CCAD said.
Common symptoms and risk factors associated with the condition that are often ignored by patients include recurrent venous thrombosis, arm pain, and exercise-related thrombosis, as well as arm swelling, discoloration, and limb heaviness.
“Medication to dissolve blood clots is typically administered as a primary treatment, with surgery being considered in severe cases to widen the area around the subclavian vein,” Dr Younes said.
Faster recovery time
Dr Usman Ahmad, department chair of thoracic surgery in the Heart, Vascular and Thoracic Institute, noted that the innovative minimally invasive technique with precise and targeted treatment resulted in improved outcomes and faster recovery times for patients suffering from VTOS.
“The use of robotic technology has revolutionised the way we approach complex vascular conditions like VTOS. By utilising this advanced technique, we can provide our patients with superior care, and deliver outcomes that were previously unattainable, allowing us to offer accessible healthcare to the community and wider region.”
Dr Ahmad pointed out that untreated VTOS poses risks due to potential blood clot formation in the subclavian vein.
“This compression can obstruct blood flow to the arm or hand or lead to a pulmonary embolism if the clot travels to the lungs. Individuals participating in regular exercise should be aware of the signs of VTOS and seek medical attention promptly if symptoms arise, to prevent complications,” Dr Ahmad added.