Marcin Zieliński, MD, PhD

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Presentation transcript:

Technique and Application of Transcervical Extended Mediastinal Lymphadenectomy in Thoracic Surgery Marcin Zieliński, MD, PhD Operative Techniques in Thoracic and Cardiovascular Surgery Volume 14, Issue 4, Pages 336-348 (December 2009) DOI: 10.1053/j.optechstcvs.2009.11.001 Copyright © 2009 Elsevier Inc. Terms and Conditions

Figure 1 Extent of removal of the mediastinal nodes during TEMLA. n. = nerve; PA = pulmonary artery; TEMLA = transcervical extended mediastinal lymphadenectomy. Operative Techniques in Thoracic and Cardiovascular Surgery 2009 14, 336-348DOI: (10.1053/j.optechstcvs.2009.11.001) Copyright © 2009 Elsevier Inc. Terms and Conditions

Figure 2 The view of the position of the members of the operating team. Operative Techniques in Thoracic and Cardiovascular Surgery 2009 14, 336-348DOI: (10.1053/j.optechstcvs.2009.11.001) Copyright © 2009 Elsevier Inc. Terms and Conditions

Figure 3 Dissection of the right laryngeal recurrent nerve. a. = artery; n. = nerve. Operative Techniques in Thoracic and Cardiovascular Surgery 2009 14, 336-348DOI: (10.1053/j.optechstcvs.2009.11.001) Copyright © 2009 Elsevier Inc. Terms and Conditions

Figure 4 Dissection of the left laryngeal recurrent nerve. To expose the nerve, the vascularized fascial layers covering the nerve must be divided. a. = artery; n. = nerve. Operative Techniques in Thoracic and Cardiovascular Surgery 2009 14, 336-348DOI: (10.1053/j.optechstcvs.2009.11.001) Copyright © 2009 Elsevier Inc. Terms and Conditions

Figure 5 Dissection of the highest mediastinal nodes (station 1). a. = artery; n. = nerve; v. = vein. Operative Techniques in Thoracic and Cardiovascular Surgery 2009 14, 336-348DOI: (10.1053/j.optechstcvs.2009.11.001) Copyright © 2009 Elsevier Inc. Terms and Conditions

Figure 6 Dissection of the lower paratracheal nodes (station 4R) from the ascending aorta, the azygos vein, the trachea, and the right main bronchus. SVC = superior vena cava; v. = vein. Operative Techniques in Thoracic and Cardiovascular Surgery 2009 14, 336-348DOI: (10.1053/j.optechstcvs.2009.11.001) Copyright © 2009 Elsevier Inc. Terms and Conditions

Figure 7 Dissection and removal of the left lower paratracheal nodes (station 4L). n. = nerve. Operative Techniques in Thoracic and Cardiovascular Surgery 2009 14, 336-348DOI: (10.1053/j.optechstcvs.2009.11.001) Copyright © 2009 Elsevier Inc. Terms and Conditions

Figure 8 View of the subcarinal region after removal of the subcarinal (station 7) and the periesophageal (station 8 nodes). a. = artery; SVC = superior vena cava; v. = vein. Operative Techniques in Thoracic and Cardiovascular Surgery 2009 14, 336-348DOI: (10.1053/j.optechstcvs.2009.11.001) Copyright © 2009 Elsevier Inc. Terms and Conditions

Figure 9 Entrance to the left para-aortic space containing the para-aortic (station 6) and the aorta-pulmonary window (station 5) nodes. n. = nerve; v. = vein. Operative Techniques in Thoracic and Cardiovascular Surgery 2009 14, 336-348DOI: (10.1053/j.optechstcvs.2009.11.001) Copyright © 2009 Elsevier Inc. Terms and Conditions

Figure 10 View of the aorta-pulmonary window area after dissection of the station 5 and station 6 nodes. a. = artery; n. = nerve; v. = vein. Operative Techniques in Thoracic and Cardiovascular Surgery 2009 14, 336-348DOI: (10.1053/j.optechstcvs.2009.11.001) Copyright © 2009 Elsevier Inc. Terms and Conditions

Figure 11 Dissection of the prevascular (station 3A). SVC = superior vena cava; v. = vein. Operative Techniques in Thoracic and Cardiovascular Surgery 2009 14, 336-348DOI: (10.1053/j.optechstcvs.2009.11.001) Copyright © 2009 Elsevier Inc. Terms and Conditions