Thoracic outlet syndrome (TOS) encompasses a range of symptomatology, including paresthesia, pain, and swelling of the upper extremities secondary to compression of the brachial plexus or subclavian vasculature in the thoracic outlet [1,2]. TOS is broad and is further delineated among the neurogenic, arterial, and venous subtypes, as well as a number of patient population considerations, such as athletes and hemodialysis dependency [1,2]. Of the subtypes, neurogenic TOS (nTOS) comprises 95% of TOS cases [3]. Physical therapy is the first-line treatment of nTOS, however, it is not effective in most patients [4]. When nonsurgical treatment methods fail, the mainstay of treatment is first-rib resection (FRR), with anterior and middle scalenectomy for decompression of the thoracic outlet structures.

Throughout the past 6 decades, first-rib resection has been performed via various approaches, including the supraclavicular, posterior, infraclavicular, transaxillary, and transthoracic techniques [5,6]. Although minimally invasive techniques were first described in 1999, the utilization of thoracoscopy was not initially favored due to the limitations of mobility of thoracoscopic instruments [6,7]. With the introduction of robotic-assisted surgery, however, minimally invasive techniques have been adopted and often preferred over open techniques due to retraction-free, improved exposure of the thoracic outlet structures, superior maneuverability of the instruments, and excellent postoperative outcomes.