VATS First Rib Resection

I published this technique many years ago. The idea came to me while performing VATS procedures, as the first rib is well visualized. On the very first case I asked a neurosurgeon to assist us, as neurosurgeons are very familiar with small drills. After that I switched to an endoscopic rib cutter, which works great. The other techniques I was taught to use for first rib resection lacked good visualization of the structures involved. I was looking for something better. The VATS technique of first rib resection is a beautiful dissection where all is seen. The results are far superior compared to the transaxillary approach. Years later after the first cases, Rob McKenna asked me to prepare a VATS first rib resection chapter for his VATS book, which I completed. If you perform the first rib resection procedure-do it by VATS-you will then only do VATS! Randall Wolf MD University of Texas Texas Medical Center Houston, Texas

An excellent technique Dr. Marshall. Having performed VATS lobectomies/ segmentectomies and sympathectomies for many years there is no better visualisation of the first rib and neurovssculsr structures than by VAT. I have just one question. Why did you elect to use a single lumen ETT? Regards.

Thank you for your comments. In our institution, a single lumen can be easily placed by any anesthesiologist but a double lumen requires additional expertise. Routine use of a single lumen tube in cases such as these, allows us to save time in patient preparation and induces less trauma to the patient's airway.