BACKGROUND: The management of heavily adhesion caused by enlarged or calcified lymph nodes is long been one of the most common difficulties in lobectomy. Some of the lymph nodes, known as "the doornail lymph node", develop such massive adhesions that it significantly elevated the risk of uncontrollable bleeding and consequent conversion. METHODS: We performed a triple portal video-assisted thoracic surgery procedure. Lymph nodes were managed with coagulator, aspirator, scissors and suture. Arteries, veins and bronchus were ligated with stapler. RESULTS: One case of a 74-year-old female patient with multiple doornail lymph nodes was presented. An optimal technique to manage these lymph nodes was utilized: first, dissect the sheath of the blood vessel to find a bypass, second, remove the calcified core of the lymph node, and last, suture through the lymph node to ligate the adjacent artery. The surgery was successfully performed without complication. CONCLUSIONS: The sequential technique of sheath dissection, core removal and suture ligation might be an optimal procedure in the management of doornail lymph node.
BACKGROUND: The management of heavily adhesion caused by enlarged or calcified lymph nodes is long been one of the most common difficulties in lobectomy. Some of the lymph nodes, known as "the doornail lymph node", develop such massive adhesions that it significantly elevated the risk of uncontrollable bleeding and consequent conversion. METHODS: We performed a triple portal video-assisted thoracic surgery procedure. Lymph nodes were managed with coagulator, aspirator, scissors and suture. Arteries, veins and bronchus were ligated with stapler. RESULTS: One case of a 74-year-old female patient with multiple doornail lymph nodes was presented. An optimal technique to manage these lymph nodes was utilized: first, dissect the sheath of the blood vessel to find a bypass, second, remove the calcified core of the lymph node, and last, suture through the lymph node to ligate the adjacent artery. The surgery was successfully performed without complication. CONCLUSIONS: The sequential technique of sheath dissection, core removal and suture ligation might be an optimal procedure in the management of doornail lymph node.