Order of Operative Steps. The order of the steps for video-assisted first rib resection is as follows: lateral decubitus position with the arm elevated on an airplane support, complete mobilization of the rib, excision of a 1-cm piece of the rib in the mid-clavicular line, and removal of the anterior and posterior pieces of the rib. 3 dramatically since 1861 when cervical rib resection was introduced [1]. Table 1 describes the evolution of these procedures. Presently, transaxillary ?rst rib resection and transcervical anterior and middle scalenectomy are the most popular and standard procedures for the surgical treatment of TOS. First rib resection Transaxillary first rib resection is performed for patients with thoracic outlet obstruction. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure. lateral transaxillary first rib resection and 23 who had bilateral operations, for a total of 282 procedures. Females outnumbered males by 3.5:l. There was no significant predilection for hand dominance. The youngest patient was 14 years old and the oldest was 55 years. The average age of patients when first seen was A Video-Assisted Thoracoscopic Approach to Transaxillary First Rib Resection Article in Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 10(1):21-6 · February 2015 A First rib resection is a surgical procedure used in humans to treat thoracic outlet syndrome (TOS). It is often accompanied by scalenectomy, or removal of the nearby anterior scalene muscle.It involves the surgical removal of a segment of the first rib, which is the rib closest to the head, under the collar bone. First Rib Resection For Thoracic Outlet Syndrome (TOS) Thoracic Outlet Syndrome Thoracic Outlet Syndrome (TOS) is caused by pressure in the neck on the nerves and/or blood vessels that go into the arm. You may have pain, numbness, tinglin