Non-grasping en bloc mediastinal lymph node dissection through uniportal video-assisted thoracic surgery for lung cancer surgery.

Uniportal video-assisted thoracic surgery (VATS) has been demonstrated to be feasible, safe, and effective for lung cancer surgery compared with traditional multi-portal VATS. However, complete mediastinal lymph node dissection (MLND) through uniportal VATS is still a difficult work due to more limited access, and most thoracic surgeons use strategies of grasping, accompanied with which are complicated instrumentation and mutual interference among them. To simplify the instrumentation and make MLND more comfortable, we developed the method of "non-grasping en bloc MLND" and applied it during uniportal VATS lung cancer surgery. Two main instruments (suction and energy devices) were developed with diversified use. And only the two instruments were used during MLND following the strategy of "non-grasping". This technique incorporates with several advantages, such as: simplified instrumentation, decreased risk of damages to lymph nodes, and en bloc dissection. Considering the limited access, this technique fits well with the uniportal procedure and truly interprets the concept of "less is more" during uniportal VATS MLND.