Routine Systematic Mediastinal Nodal Dissection During VATS Major Pulmonary Resections—The Southampton Technique
By Khalid Amer, FRCS(C Th)
Systematic nodal dissection is increasingly becoming an integral part of VATS lobectomy for early lung cancer. This video gives details demonstrating the author's technique of en-bloc mediastinal nodal dissection, which is a modification of the original Naruke technique. The azygos vein and the ligamentum arteriosum are always preserved. The relevant anatomical details of the thoracic cavity are outlined and labeled. The tricks of planning the dissection of each station and the caveats of possible damage to nearby structures are emphasized. On the right side, all lymph nodes at stations 2-4, 7, 8, 9, 10, and 11 and on the left stations 4-6, 7, 8, 9, 10, 11, and 3 (when indicated) are dissected en-bloc. The video demonstrates how to consistently get to the subcarinal and precarinal nodes from the left side and how to avoid recurrent laryngeal nerve injury.
The author has received honoraria in the past from Ethicon Endosurgery for educational contributions.