Thoracic outlet syndrome is very rare thoracic surgical neurovascular disorder which is subject to compression by bones and muscular structures impinging upon the subclavian artery, vein k brachial plexus. The operative therapy is applied to remove the anatomical abnormal structures which leads to the compression to develop symptoms. We have operated one patient with thoracic outlet syndrome by excision of cervical ribs & first ribs with using transaxillary & posterior parascapular approaches in the thoracic surgical department, Yonsei University College of medicine, The post-operative courses has been uneventful for 7 months to now.