Anatomic and clinical study of endoscopic assisted surgery via supraclavicular approach in thoracic outlet syndrome

Objective To explore the anatomical basis and simulated operation of a new minimally invasive treatment for thoracic outlet syndrome (TOS) through supraclavicular approach. Methods Local dissection in both sides was performed at lateral and anterior neck region in 5 cadavers. The endoscopic approach and operative plane were determined according to their anatomical characteristics, and the distance from the approach point to the transverse cervical artery was measured. Endoscopic surgery was simulated on a fresh cadaver to observe the tissue level and perform the release of brachial plexus. Results The distance between sternum head of sternocleidomastoid muscle and mastoid process was (13.78±0.94) cm. The distance between the cross border of the posterior border of sternocleidomastoid muscle and the upper border of the 5th root of brachial plexus and sternal head was measured (7.79±0.60) cm, which account for (56.58±2.78)% of the total length of sternocleidomastoid muscle. The anatomical study showed the optimum surgical entrance point: 60% of the total length of sternal head to mastoid process, 60° to the healthy side of the head, and 1 cm of longitudinal incision. The incision was performed on fresh human specimens and the transverse cervical artery was the landmark anatomical structure under the endoscope. Conclusion Supraclavicular approach endoscopic minimally invasive treatment for TOS is feasible, which can clearly expose brachial plexus nerve to perform brachial plexus neurolysis operation. It has clinical application value. Key words: Thoracic outlet syndrome; Dissection; Endoscopes; Surgical approach