Feasibility and Efficacy of VideoAssisted Mediastinoscopic Lymphadenectomy

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Feasibility and Efficacy of Video-Assisted
Mediastinoscopic Lymphadenectomy

• Hong Kwan Kim, MD, Young Mog Shim, MD

Department of Thoracic and Cardiovascular
Surgery Sungkyunkwan University School of
Medicine Samsung Medical Center
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Background

• Mediastinal lymph node dissection
• Accurate staging in patients with NSCLC
• Critical for planning treatment strategies
• Important for defining prognostic subgroups
• VATS lobectomy
• Advances in thoracoscopic surgery techniques
• Widely adopted in patients with stage I NSCLC

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Background

• Mediastinal LN dissection via VATS
• Might be difficult to get excellent exposure
• Concern about incomplete LN dissection
• Objectives
• To evaluate the feasibility, safety, and efficacy
  of lymphadenectomy using videomediastinoscope

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Operative Techniques

• Twin-bladed expanding videomediastinoscope
• Supine position with neck hyperextension
• 2cm-long skin incision was made 1cm above the
  suprasternal notch
• Subcarinal station
• Left paratracheal station
• Right paratracheal station
• Video-Assisted Mediastinoscopic Lymphadenectomy

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Summary

• Advantages over conventional mediastinoscope
• Enhanced exposure
• Bimanual dissection
• User-friendly / accessible to trainees
• Limitations
• Another neck incision
• Sampling rather than dissection on left side
• Limited in extranodal invasion