I have bilateral venous TOS. I am one year post robotic rib resection which did nothing to help my symptoms. I have new issues that have crept up since surgery. TOS is a very individualized disease so surgical outcomes will vary. In regards to the robotic approach, the surgeon goes through the rib cage, deflates the lung, and then approaches the rib from the inside. They then remove the bony knuckle closest to the sternum leaving the rest of the rib and scalenes in tact. The surgical robot instruments and chest tube get close to the intercostal nerve which in my case left me with nerve damage. The surgeon only advised me of this possible side effect after I went through the procedure. The end result is pain, numbness, and shallow breathing with some days better than others. mix in some new emotional baggage to contend with. You should exhaust all other options before entertaining surgery regardless of the approach.