CHAPTER 20 Video-Assisted Mediastinoscopy—Video 20
Introduction
Mediastinoscopy is an important staging procedure for lung cancer. Development of video-assisted mediastinoscopy has greatly improved the quality and safety of the procedure that can be performed. Node dissection can be performed with the standard video mediastinoscope.
Approach to Video-Assisted Mediastinoscopy
Order of Operative Steps
Mediastinoscopy can be performed inferiorly to superiorly or vice versa. Usually, surgeons start inferiorly, and the steps of the procedure are as follows: subcarinal nodes, pretracheal nodes, level 4 nodes, and level 2 nodes.
Video-Assisted Mediastinoscopy
Step 1. Incision
♦ Make a 2-cm incision (Figure 20-1) transversely in the base of the neck that is 1 or 2 fingerbreadths above the sternal notch.
♦ With electrocautery, cut transversely through the platysma muscle and then vertically in the midline between the strap muscles.
♦ With a closed Kelly clamp, bluntly dissect in the midline between the muscles to expose the trachea.
♦ The finger breaks through the pretracheal fascia to mobilize the lymph nodes as much as possible. This often is the safest method to dissect matted nodes away from vessels.
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