The goal of surgical treatment of thoracic outlet syndrome is to decompress the thoracic outlet. There is no consensus regarding the surgical approach. Thoracic outlet decompression can be performed by direct open transaxillary, supraclavicular, and infraclavicular procedures, and the decision regarding which to choose can be a difficult one. Recently, the thoracoscopic approach has become an alternative to the classic open approach. This video tutorial demonstrates first rib resection by VATS for thoracic outlet syndrome and explains the technical aspects of the procedure.