Endoscopic decompression of the brachial plexus in the thoracic aperture area

Specialists of the State Clinical Hospital named after V.M. Buyanov were the first in Russia to perform a unique operation — endoscopic decompression of the brachial plexus in the area of the thoracic outlet.

A 73-year-old female patient came to the hospital with complaints of severe pain in the right shoulder and weakness in the hand. After suffering a fracture of the surgical neck of the shoulder (six months ago), pain and weakness persisted. Acute pain did not allow the patient to sleep. Pain syndrome was assessed at 10 points on a visual analogue scale. After the diagnosis, the “superior thoracic outlet” syndrome was identified — a pathological condition in which compression of the brachial plexus and vascular bundle occurs in the space between the first rib and the collarbone. The problem was that this space is anatomically quite narrow, and with certain pathological processes it has become even smaller. Clinically, thoracic outlet syndrome manifested itself in the form of severe neuropathic pain in the shoulder and upper limb, weakness and numbness in the hand, and limited movement in the shoulder joint. Conservative treatment in this case was ineffective, since there is an anatomical narrowing of the space in the area of the neurovascular bundle. This problem could be solved by classical surgery, but this method is carried out through a large skin incision, massive dissection and traumatization of soft tissues. Such operations are accompanied by significant blood loss, the risk of infectious complications and the formation of postoperative hematomas. In this regard, a medical consultation was convened, at which it was decided to apply the technique of endoscopic decompression of the brachial plexus in the area of the thoracic aperture, which was developed within the walls of our hospital, on the basis of the Department of Traumatology and Orthopedics of the RUDN University. The following specialists assisted in the development of this technique: the chief physician of the City Clinical Hospital named after. V.M. Buyanova Salikov Alexander Viktorovich, traumatologist-orthopedist, professor of the Department of Traumatology and Orthopedics of RUDN, Doctor of Medical Sciences Lazko Fedor Leonidovich, neurosurgeon, deputy chief physician for surgical care, candidate of medical sciences Asratyan Sarkis Albertovich.

The operation was performed by two specialists: orthopedic traumatologist, candidate of medical sciences Evgeniy Aleksandrovich Belyak and neurosurgeon Dmitry Lvovich Paskhin. Until now, similar operations were performed only openly with significant surgical damage to tissue. During the operation, all scar and adhesive tissue in the area of the thoracic outlet was removed endoscopically through small punctures. Thus, decompression of the brachial plexus was performed.

Thanks to the use of the endoscopic method, postoperative pain syndrome is significantly reduced, the cosmetic result is improved, and the rehabilitation process is accelerated. The patient felt the effect of the operation the very next day after the operation in the form of a marked reduction in pain, restoration of sensitivity and strength in the hand area.

Rehabilitation after this type of endoscopic intervention is much easier and faster; stitches can be removed on the 7th day after surgery.