BACKGROUND: Surgical treatment of lung cancer has evolved to a minimally invasive approach and currently is recognized as an acceptable treatment for resectable non-small cell lung cancer (NSCLC). As the volume and complexity of cases has increased technical difficulties had arisen. Hilar and sublobar lymph nodes can represent a challenge for video-assisted thoracoscopic surgery (VATS) surgeons in order to complete a safe dissection of vascular and bronchial structures without complications or conversion. It is not unusual the patients with smoking history or benign infections in the past present with enlarged calcified nodes that are fused to the hilum, fissure and specially the bronchus which can lead to an accident during the procedure if the surgeon has no experience handling this issue. As the amount of surgeons carrying out VATS lobectomies grows it is very important for them to know what to do in this specific case so the completion of the procedure can be achieved safely. METHODS: The coordination between the surgeon and the assistant is very important in order to carry out the procedure without discomfort positions and good visualization, the use of energy devices in expert hands can help considerably during the dissection of lymph nodes in the hilum and fissure reducing the bleeding, which provides a clean operative field. It is a necessary maneuver during the dissection to find the correct adventitial plane between the lymph node and the structure before passing it. RESULTS: The videos in this article show the different maneuvers a VATS surgeon can implement when facing enlarged fussed lymph nodes in the hilum, fissure or mediastinum. Improving exposure, opening the fissure, using energy and carrying out the dissection through the correct plane are keys to complete the procedure successfully. CONCLUSIONS: With growing experience in uniportal VATS and advances in surgical technology, enlarged or fussed lymph nodes are no longer a contraindication to complete a VATS lobectomy, experience VATS surgeons have a repertory of options in order to perform a safe and effective dissection.
BACKGROUND: Surgical treatment of lung cancer has evolved to a minimally invasive approach and currently is recognized as an acceptable treatment for resectable non-small cell lung cancer (NSCLC). As the volume and complexity of cases has increased technical difficulties had arisen. Hilar and sublobar lymph nodes can represent a challenge for video-assisted thoracoscopic surgery (VATS) surgeons in order to complete a safe dissection of vascular and bronchial structures without complications or conversion. It is not unusual the patients with smoking history or benign infections in the past present with enlarged calcified nodes that are fused to the hilum, fissure and specially the bronchus which can lead to an accident during the procedure if the surgeon has no experience handling this issue. As the amount of surgeons carrying out VATS lobectomies grows it is very important for them to know what to do in this specific case so the completion of the procedure can be achieved safely. METHODS: The coordination between the surgeon and the assistant is very important in order to carry out the procedure without discomfort positions and good visualization, the use of energy devices in expert hands can help considerably during the dissection of lymph nodes in the hilum and fissure reducing the bleeding, which provides a clean operative field. It is a necessary maneuver during the dissection to find the correct adventitial plane between the lymph node and the structure before passing it. RESULTS: The videos in this article show the different maneuvers a VATS surgeon can implement when facing enlarged fussed lymph nodes in the hilum, fissure or mediastinum. Improving exposure, opening the fissure, using energy and carrying out the dissection through the correct plane are keys to complete the procedure successfully. CONCLUSIONS: With growing experience in uniportal VATS and advances in surgical technology, enlarged or fussed lymph nodes are no longer a contraindication to complete a VATS lobectomy, experience VATS surgeons have a repertory of options in order to perform a safe and effective dissection.
Authors: Diego Gonzalez-Rivas; Eva Fieira; Maria Delgado; Lucia Mendez; Ricardo Fernandez; Mercedes de la Torre Journal: J Thorac Dis Date: 2013-08 Impact factor: 2.895
Authors: Eva Fieira Costa; María Delgado Roel; Marina Paradela de la Morena; Diego Gonzalez-Rivas; Ricardo Fernandez-Prado; Mercedes de la Torre Journal: J Thorac Dis Date: 2014-10 Impact factor: 2.895
Authors: Ricardo Fernández Prado; Eva Fieira Costa; María Delgado Roel; Lucía Méndez Fernández; Marina Paradela de la Morena; Mercedes de la Torre; Diego Gonzalez-Rivas Journal: J Thorac Dis Date: 2014-10 Impact factor: 2.895
Authors: María Delgado Roel; Eva María Fieira Costa; Diego González-Rivas; Lucía Méndez Fernández; Ricardo Fernández Prado; Mercedes de la Torre Journal: J Thorac Dis Date: 2014-10 Impact factor: 2.895
Authors: Diego Gonzalez-Rivas; Marina Paradela; Ricardo Fernandez; Maria Delgado; Eva Fieira; Lucía Mendez; Carlos Velasco; Mercedes de la Torre Journal: Ann Thorac Surg Date: 2012-12-05 Impact factor: 4.330
Authors: Diego Gonzalez-Rivas; Eva Fieira; Maria Delgado; Lucía Mendez; Ricardo Fernandez; Mercedes de la Torre Journal: J Thorac Dis Date: 2014-06 Impact factor: 2.895