Objective: Multiple approaches for decompression of thoracic outlet syndrome (TOS) have been described in the literature. A supraclavicular approach is usually preferred for patient with a neurogenic etiology to TOC. However, the minimally invasive robotic approach can sometimes provide similar outcomes, better exposure, and less morbidity. The purpose of this video is to describe our robotic approach to first rib resection in a patient with neurogenic TOS. Case Video Summary: The patient is a 40-year-old gentleman with a 2 year history of progressive worsening paresthesia, weakness, and pain in his left hand. Upon a thorough work up, the patient elected to undergo left robotic assisted resection of his first rib. A 3-arm-3-incision approach was utilized. The left first rib was identified. The phrenic nerve, brachial plexus, subclavein artery, and subclavian vein were all identified. Dissection was started along the first rib, and the rib was divided anteriorly and posteriorly. Blunt dissection was performed to break down the adhesions of the brachial plexus to the first rib. The patient tolerated the procedure well. He had no new neurological deficits postoperatively. Subjectively he reported resolution of the paresthesia after surgery. The chest drain was removed on POD#2 and he was discharged home on POD#3. Conclusions: In select patients with neurogenic TOS, minimally invasive robotic-assisted approach for left first rib resection and decompression is feasible, safe, and reproducible.