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What Is a First Rib Resection?

A first rib resection is a surgery to remove your first rib. Thoracic surgeons offer this surgery to treat thoracic outlet syndrome

Thoracic outlet syndrome is compression of the nerves or blood vessels in the space between your first rib, collarbone, and back muscles. Your cardiothoracic surgeon will create more space in your thoracic outlet with a first rib resection to relieve this compression.

Why Choose University of Utah Health?

At U of U Health, our thoracic surgeons are among only a few in the nation that offer robotic surgery for thoracic outlet syndrome. We use the newest, most advanced techniques that offer patients optimal outcomes. Compared with patients who have open surgery, our patients recover more quickly and experience less pain. 

Our cardiothoracic surgery team performs among the highest volume of procedures in the Mountain West region. We continually research and implement new treatments to stay on the leading edge of surgical care

Candidate Criteria for First Rib Resection

You may be a candidate for a first rib resection if you have any type of thoracic outlet syndrome, including:

  • neurogenic thoracic outlet syndrome (compression in the nerves of your shoulder, arm, and hand);
  • venous thoracic outlet syndrome (compression in the veins under your collarbone); or
  • arterial thoracic outlet syndrome (compression in the arteries under your collarbone).

We typically recommend a first rib resection immediately if you have arterial or venous thoracic outlet syndrome. We may also recommend surgery if you have neurogenic thoracic outlet syndrome symptoms that haven’t improved with physical therapy.

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How to Prepare for a First Rib Resection

Your cardiothoracic surgeon will give you instructions to prepare for a first rib resection. You usually don’t need to do anything special. You may need to stop taking certain medications, such as blood thinners, for a brief period before the operation.

What to Expect during First Rib Resection

Our cardiothoracic surgeons use a robotic approach for thoracic outlet syndrome surgery. During the procedure, we will:

  • make four one-half-inch incisions (cuts) along your side;
  • insert small surgical tools and a camera through the incisions;
  • use a surgical robotic arm to remove your first rib safely and precisely.

Compared with other techniques, the robotic approach allows us to operate more precisely with a lower risk of complications.

After First Rib Resection

Most people stay in the hospital for one to two days after a first rib resection.

First Rib Resection Aftercare

You’ll have a drainage tube in one of the incisions while you recover in the hospital. Your surgical team will give you post-operative instructions for any precautions you need to take with the tube. We’ll remove this tube before you return home.

First Rib Resection Recovery

You’ll have to limit how much you use your arms for the first two weeks after surgery. You’ll have to avoid heavy lifting entirely.

Most people can return to office jobs about two weeks after a robotic first rib resection. If you have a more active job, you may need to wait three to four weeks.

Pain after Rib Resection

You may have some chest or arm pain for a few weeks after a first rib resection. Your cardiothoracic surgeon will give you pain medication if needed.

First Rib Resection Scar

Scars from a robotic first rib resection are minimal. You’ll have four small scars on your side that get less noticeable over time. Your arm usually covers them.

First Rib Resection Rehabilitation

You’ll start physical therapy about two weeks after a first rib resection. The physical therapist prescribes stretching and strengthening exercises. These movements help to break up scar tissue to increase your function and mobility.

First Rib Resection Complications

Traditional first rib resection techniques involve larger incisions (cuts) and less visibility for your surgeon. These techniques carry risks of bleeding or damage to the nerves going to your arm. These risks are significantly lower with the robotic technique that we use.

Thoracic Outlet Syndrome Surgery Success Rate

Thoracic outlet syndrome surgery has excellent success rates. People with neurogenic thoracic outlet syndrome often immediately experience improved function and less numbness. Surgery is often the most effective treatment for people with arterial or venous thoracic outlet syndrome.

Can Thoracic Outlet Syndrome Come Back after Surgery?

Thoracic outlet syndrome doesn’t usually come back after surgery. Because your surgeon increases the space in your thoracic outlet, it’s unlikely that your nerves or blood vessels will become compressed again. Sometimes you may need additional procedures to remove scar tissue or a blood clot if you have venous thoracic outlet syndrome.

Life after thoracic outlet surgery typically involves a return to your usual activities. Participating in physical therapy increases the chances of long-term success. 

How to Schedule an Evaluation with Our Cardiothoracic Specialists

To make an appointment with our cardiothoracic team, call 801-585-6740. We encourage you to get a referral from your neurologist or primary care provider. However, we do accept self-referrals.

To refer a patient for cardiothoracic surgery, complete our referral form or call 801-585-6740.