Video-Assisted Mediastinoscopic Surgery: Clinical Feasibility and Accuracy of Mediastinal Lymph Node Staging Biruta Witte, MD, Michael Wolf, MD, Martin.

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Presentation transcript:

Video-Assisted Mediastinoscopic Surgery: Clinical Feasibility and Accuracy of Mediastinal Lymph Node Staging Biruta Witte, MD, Michael Wolf, MD, Martin Huertgen, MD, Heikki Toomes, MD The Annals of Thoracic Surgery Volume 82, Issue 5, Pages 1821-1827 (November 2006) DOI: 10.1016/j.athoracsur.2006.05.042 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Linder-Dahan videomediastinoscope. The twin-bladed speculum is spread open to create a wide operative field for bimanual preparation. The Annals of Thoracic Surgery 2006 82, 1821-1827DOI: (10.1016/j.athoracsur.2006.05.042) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Video-assisted mediastinoscopic lymphadenectomy dissection technique. First, the bifurcation and pulmonary artery are exposed. (a) 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. Then, the mediastinoscope is retracted to the innominate artery. (b) The pleura parietalis and vena cava superior are exposed, and the pretracheal and right paratracheal fat pad is removed en bloc down to the azygos vein and the right main bronchus. Finally, the left recurrent nerve is visualized, and the pretracheal fascia is divided between the nerve and the left border of the airway. (c) The left paratracheal and tracheobronchial adipose tissue is carefully dissected, and all lymph nodes removed. The Annals of Thoracic Surgery 2006 82, 1821-1827DOI: (10.1016/j.athoracsur.2006.05.042) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Study collective. Because 226 consecutive video-assisted mediastinoscopic surgery (VAMS) patients were documented and studied, the collective is heterogeneous and this summary may be useful. Indication and procedure subgroups are shown. In the video-assisted mediastinoscopic lymphadenectomy (VAMLA) subgroup, 125 of 144 procedures were complete, and 130 of 144 patients were reassessed at open surgery. The Annals of Thoracic Surgery 2006 82, 1821-1827DOI: (10.1016/j.athoracsur.2006.05.042) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Video-assisted mediastinoscopic surgery (VAMS) complication rates. The overall complication rate of VAMS in this study was 3.9%. Complications were more frequent with video-assisted mediastinoscopic lymphadenectomy (VAMLA) (5.6%) than with lesser procedures (1.2%), and most frequent with incomplete, difficult procedures. Compared with other data (table below), complication rates of VAM are in the range of conventional mediastinoscopy, and those of VAMLA correspond to open lymphadenectomy. The Annals of Thoracic Surgery 2006 82, 1821-1827DOI: (10.1016/j.athoracsur.2006.05.042) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Video-assisted mediastinoscopic surgery repair of vena azygos. The confluence of superior vena cava and vena azygos is compressed by a sponge stick. The tear in the vena azygos is compressed by a suction device. On the left of the suction device, one clip partially occludes the injury. Two more clips had to be placed closer to the venous confluence. The Annals of Thoracic Surgery 2006 82, 1821-1827DOI: (10.1016/j.athoracsur.2006.05.042) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions