Purpose: Thoracic outlet syndrome (TOS) is a heterogeneous condition resulting from compression of neurovascular structures at the thoracic outlet. Transaxillary first rib resection (TAFRR) is widely used for surgical decompression; however, reported outcomes vary across centres, and contemporary Australian data are limited. This variability creates uncertainty regarding early safety profiles and patient counselling. This study aims to evaluate early outcomes following TAFRR in a high-volume tertiary centre. Methodology: A retrospective cohort study in of consecutive adult patients who underwent TAFRR for TOS between February 2010 and October 2025 is in progress at Royal Prince Alfred Hospital and affiliated private vascular practices. De-identified data is extracted from electronic medical records, anaesthetic and vascular audit databases, and follow-up documentation. Primary outcomes include 30-day postoperative complications, length of stay (median 3 days), unplanned readmissions, and symptom status at six-week follow-up. Secondary outcomes include early re-intervention and functional recovery where recorded. Outcomes will be summarised using descriptive statistics and compared with international benchmarks. Results: Approximately 140 patients are expected to meet inclusion criteria, predominantly aged 20–49 years. Early outcomes are being reported in aggregate, including perioperative complication rates (pneumothorax ~33%), short-term symptom improvement, and early re-intervention. These findings will allow comparison with international series reporting complication rates of 5–35%. Conclusion: This study will provide contemporary Australian data on the early safety and effectiveness of transaxillary first rib resection for thoracic outlet syndrome. The findings will support informed patient counselling, institutional quality assurance, and benchmarking within the Australasian surgical community.