Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA)

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Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA) Biruta Witte, MD, Martin Hürtgen, MD Journal of Thoracic Oncology Volume 2, Issue 4, Pages 367-369 (April 2007) DOI: 10.1097/01.JTO.0000263725.89512.d7 Copyright © 2007 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 The Linder-Dahan videomediastinoscope is a cross-breed of a conventional mediastinoscope and a spreadable laryngoscope. The blades are spread open up to 32 mm by turning a screw (a). Lowering the lower blade by turning the spacer (b) allows an additional 20 mm of operating field. The tip of the upper blade (c) is designed to keep surrounding structures, e.g., fatty tissue or the pulmonary artery, out of the operating field. It accommodates light, optic, continuous suction, and irrigation. Journal of Thoracic Oncology 2007 2, 367-369DOI: (10.1097/01.JTO.0000263725.89512.d7) Copyright © 2007 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Video-assisted mediastinoscopic lymphadenectomy dissection is guided by anatomical landmarks very similar to open lymphadenectomy. (a) First, bifurcation and pulmonary artery are exposed. The tip of the mediastinoscope is placed below the artery, and the subcarinal compartment is excised en bloc, following the medial borders of both main bronchi and the anterior esophagus wall. (b) Then, the mediastinoscope is retracted to the innominate artery. The pleura parietalis and vena cava superior are exposed, and the pre- and right paratracheal fat pads are removed en bloc down to the azygos vein and the right main bronchus. (c) Finally, the left recurrent nerve is visualized, and the pretracheal fascia is divided between the nerve and the left border of the airway. The left paratracheal and tracheobronchial adipose tissue is carefully dissected, and all visible lymph nodes removed. (Reprinted from Witte et al.2 with permission from the Society of Thoracic Surgeons.) Journal of Thoracic Oncology 2007 2, 367-369DOI: (10.1097/01.JTO.0000263725.89512.d7) Copyright © 2007 International Association for the Study of Lung Cancer Terms and Conditions