1. Virtual Mediastinoscopy for Safer and More Accurate Mediastinal Exploration 
Hiroyuki Shiono, MD, Meinoshin Okumura, MD, Noriyoshi Sawabata, MD, Tomoki Utsumi, MD, Masayoshi Inoue, MD, Masato Minami, MD, Noriyuki Tomiyama, MD, Hikaru Matsuda, MD, Yoshiki Sawa, MD 
The Annals of Thoracic Surgery 
Volume 84, Issue 3, Pages (September 2007)
DOI: /j.athoracsur
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
(A) A portion of a fly-through movie produced for virtual mediastinoscopy obtained from positron emission tomography-computed tomographic images of patient 1. (B) Corresponding view during cervical video mediastinoscopy in the same patient. The most cranial node (station 1), which should first be assessed during a cervical mediastinoscopy, was shown to be the shortest in the virtual mediastinoscopy images, based on the orientation of the surgeon. The nodes appearing next (2R and 2L) are shown in the same view as in (A). (LUL = left upper lobe; RUL = right upper lobe; TR = trachea.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Virtual mediastinoscopy images showing three-dimensional relationships between the two paratracheal nodes (2L and 2R) and surrounding structures, including the trachea. (A) Simulation of the view of the surgeon during video mediastinoscopy. (B) A suction tube can be seen at station 2R. (TR = trachea; 6 = para-aortic node.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
(A) Virtual image and (B) corresponding operative view at the mid-tracheal level. The virtual view clearly shows lymph node 4R beyond 2R. (LMB = left main bronchus; TR = trachea; 6 = para-aortic node.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
(A) Paratracheal node 2R in virtual mediastinoscopy image and (B) operative view during cervical mediastinoscopy in patient 2. The nodes, which were radioactive, but proven not to be malignant, were soft and buried in fat tissue (B). (TR = trachea.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
Virtual mediastinoscopy movie derived from enhanced computed tomographic scans of patient 3 showing the real time anatomy of the great vessels in the mediastinum in the orientation of the surgeon, including (A) the branches of the aortic arch, and (B) the azygos vein and pulmonary artery. (C) Radioactive node 4R was also visualized in virtual mediastinoscopy images obtained from positron emission tomography-computed tomographic scans and shown to be located on the cranial side of the azygos vein shown in B. (D) An incisional biopsy of 4R was performed safely and accurately. (AV = azygos vein; IA = innominate artery; LCC = left common carotid artery; LS = left subclavian artery; PA = pulmonary artery; RMB = right main bronchus; SVC = superior vena cava; TR = trachea.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

7. Fig 6
Virtual images showing a highly radioactive paratracheal node, (A) which was found located on the cranial side of the azygos vein when combined with (B) virtual images from enhanced computed tomographic scanning. (AV = azygos vein; LMB = left main bronchus; PA = pulmonary artery; RMB = right main bronchus; SVC = superior vena cava; TR = trachea.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions