Bilateral transternal first rib resection
 

Got my surgery date: 01-03-13. My surgeon, Dr. Robert Lowe, seems to know what he's doing and has done many TOS rib resections so I'm going to go for it. I feel like I can trust this doctor unlike the ones I encountered at Yale.
I see a lot of people on here (myself included!) asking for personal experiences to help them prepare for their own surgeries so it is my intention to use this thread to document mine!
I've been diagnosed with arterial, neurogenic, and to a lesser extend, venous thoracic outlet syndrome on both sides. My surgeon believes that it's better just to get it over and done with especially since I am young so I will be having both sides done at the same time. His approach is transternal so he can get out as much rib as possible and have a full view of the area. He said that since he is doing both sides at once, my sternum will need to be wired to help it heal back together properly. I've never heard of this approach before, but I do feel like he knows what he's doing. I was told to expect a 3-5 day hospital stay if everything goes according to plan and for surgery to take between 3.5 and 5 hours since both sides are being done at once.

Wish me luck! I have high hopes that next year is going to be so much better than the last!!

Both sides at once, wow.
I hope you have lots of helpers after you get back home.:grouphug:

Prepare a comfy place at home with a table or tray for everything you might need close at hand.
I'm sure you've seen most of the post op/recovery posts & tips.

Do you mean transaxial? I have never heard of transternal either.

I'm very fortunate that I have plenty of help. I'll need to do virtually nothing until I feel ready to do so. My significant other works nights and we live with my mother and stepfather who will be home in the evenings. I've got a close-knit family and a few great friends also who will be a big help when he needs a break. I work per diem, so getting time off is as easy as not taking shifts until I feel up to it and can take as few as I want when I'm ready to start up again. I'm actually really happy that he's doing both sides at once. He said that he really didn't want to wait because even though my right side is not near as symptomatic as my left, it is being restricted of just as much blood. He also saw that my left side is wasting quite badly which I didn't even notice until he took circumference measurements. I'm a little nervous about this sternum wiring thing but he does tons of these surgeries and I have a "feeling" about him that I can trust him so I'm going to go for it.

Nope, transternal so he can get both sides. He wants to be able to see everything and get the entire rib. He's going to cut clear across my chest right under the collarbone.

I've never heard of this approach and it sounds unnecessarily risky. Have you least found a journal article on this? I wouldn't rush into this and I don't recommend having both sides done at the same time.

Yes, I did find a journal article on it. It seems like the go-to approach when both sides need to be done at once due to artery compromise and the best way to get a good look at all artery damage. I guess it's not the perfect approach, but when arteries are the problem that's what they recommend. The journal says that the outcomes are good from the surgery. If you're a non-smoker and young (which I am) you heal up from it quite will with no additional complications from it. I think he's downplayed how bad things are getting with blood flow because he very sternly told me that even though my right side is not near as symptomatic that it can't wait and absolutely needs to be done.

this is what he did for my friend. Both sides at once. and he fixed her veins which were blocked.

I wish you great luck and hope the best for you. Please keep us posted on your progress.

Post the journal article if you can.

I can't find the article I read last night (of course) but I did find this which seems to be more helpful. I guess another word for the approach is infraclavicular but because he's doing it bilaterally it crosses the sternum calling it a transsternal.


"Infraclavicular First Rib Resection
The patient is positioned supine with a pad to elevate the scapula and shoulder, with the arm abducted. A muscle-splitting incision approximately 12 cm in length is carried through the pectoralis major muscle to expose the first rib below the clavicle, beginning medially at the costochondral junction. The periosteum is elevated subperiosteally from the rib, and the costochondral junction is removed piecemeal with the Leksell rongeur. The pleura can then be stripped from the posterior surface of the mobilized rib with careful blunt dissection. The rib is next retraced inward, and the neurovascular bundle traversing the costoclavicular space is palpated and retracted with the index finger. With the neurovascular structures thus constantly protected beneath the index finger and the pleura retracted, the rib with its periosteum is rongeured away, scraping off the insertions of the anterior and middle scalene muscles. Posterior to the neurovascular bundle, rib removal is accomplished by feel rather than under direct vision, but usually can be taken back to within 3 to 4 cm of the transverse process without excessive retraction of the neurovascular bundle; and in some asthenic patients, to within 1 to 2 cm of the transverse process. If a cervical rib is present,
5
it can also be trimmed through this approach. This incision can be extended slightly downward to the deltopectoral junction if the pectoralis minor tendon is to be divided. If a tear occurs in the pleura, it is closed around catheter suction with the lung inflated. The pectoral fascia, subcutaneous tissue, and skin are closed in layers. Bilateral rib resection can be done as a one-stage procedure by this technique."