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OBJECTIVE Herein we describe the development and evolution of a surgical technique that uses the robotic da Vinci Surgical System for the transaxillary approach to repair the disabling thoracic outlet syndrome (TOS). We report patient outcomes associated with the use of this robotic technique. METHODS We present a retrospective review and analysis of data collected from a sixteen-year experience of a single surgeon using a robotic surgical system and technique for TOS surgery. From the initial design of an endoscope attached to a microvideo camera in 1982 to the adoption of the monorobotic arm with integrated voice in 1998, the main objective of the transaxillary approach has always been to improve visualization of congenital cervical anomalies of the scalenus muscles. RESULTS There were no mortalities, and no patients suffered permanent neurovascular damage of the extremity. Twenty-two patients (5% of 441 operations) experienced complications. One patient experienced postoperative scarring that required a redo operation with a robotic-assisted transaxillary approach. CONCLUSIONS With its 3D visual magnification of the anatomical area, the endoscopic robotic-assisted transaxillary approach offers a safe and effective management of disabling TOS symptoms. The endoscope facilitates the observation of cervical bands and the mechanism (pathogenesis) of the neurovascular compression that causes TOS, thereby allowing complete excision of the first rib, cervical bands and scalenus muscle. We aimed to develop and perfect this robotic approach. This work is not intended to be a comparative study to nonrobotic TOS surgery.