Surgical techniques: Operative decompression using the transaxillary approach for NTOS

Most feel that patients with neurogenic thoracic outlet syndrome (NTOS) who are refractory to conservative management should undergo operative decompression. The ideal approach for NTOS should be based on the patient's symptoms and anatomy, and the surgeon's operative experience. The transaxillary approach was first described by Roos in 1966, and many surgeons prefer this approach because of its relative ease, low risk, and documented ability to improve patients' quality of life. This chapter describes the technical aspects of transaxillary fir st rib resection with attention to factors that influence short- and long-term outcome when performed in patients with NTOS.