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.

Stay updated, free articles. Join our Telegram channel

Full access? Get Clinical Tree

