Anatomic And Clinical Study Of Endoscopic Assisted Surgery Via Supraclavicular Approach In Thoracic Outlet Syndrome

Objective: To explore the surgical endoscopic treatment for thoracic outlet syndrome(TOS) by anatomy research on lateral neck region and brachial plexus. Surgical entrance point and approach, which is crucial for operation exposure, are determined by the trials undertook on the cadavers in the purpose to reduce the risk of damaging blood vessels, nerves, tendons nearby.Methods: 1. Local dissection was performed at lateral and anterior neck region in the cadavers were dissected by layers, to expose brachial plexus and select endoscopic operating interspace. 2. According to surface projection measurement of brachial plexus, the endoscopic entrance point was supposed, whose distance between transverse cervical artery was calculated in other specimens. 3. Simulated endoscopic operation in fresh cadaver was performed to separate and expose the brachial plexus. The entrance point, operating interspace and procedures were confirmed. 4. This surgical approach was applied in clinical practices, patients with thoracic outlet syndrome got benefit.Result: 1. Five adult human cadaver with both sides of sternocleidomastoid were separated, with a length of 13.78±0.94 cm. The 5th root of brachial plexus measured 7.79±0.60 cm from sternal head of sternocleidomastoid, which account for 56.58±2.78% of the total length. 2. The point, 60% from sternal head of sternocleidomastoid, measured 0.99±0.20 cm to brachial plexus and 1.44±0.40 cm to transverse cervical artery in two adult human cadaver with both sides. It is considered safe for endoscopic entrance point. 3. The optimum surgical entrance point: 60% length from sternal head of sternocleidomastoid rear side, with head 60 degrees tilting to the normal side, 1cm longitudinal incision would be safe and feasible. 4. Simulated endoscopic assisted surgery in fresh cadavers showed that operation interspace between transverse cervical artery and platysma enable operator to observe and release brachial plexus by putting endoscopic equipment from patient’s head side. 5. Two patients with TOS received this new endoscopic operation and both recovered well in our six-months follow-up assessment.Conclusion: According to the anatomical study, and simulated endoscopic assisted surgery in fresh cadavers, endoscopic assisted surgery in thoracic outlet syndrome receive good results. It benefits patients with less invasion, little scar and rapid recovery.