초록접수 현황
| 15F-235 | Video session발표 |
Left-side Video Assisted Thoracic Surgery Mediastinal Lymph Node Dissection
Kyung Wook Shin, Kwhanmien Kim, Sungjoon Park, Hyo-Jun Jang, Eunjue Yi, Sukki Cho, Sanghoon Jheon
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
Background : Mediastinal lymph node dissection is an important procedure in non-small cell lung cancer surgery. Left-side Video Assisted Thoracic Surgery (VATS) mediastinal lymph node dissection is a little more difficult than right-side.
Methods : The first port is placed at the 7th or 8th intercostal space(ICS) in the mid-axillary line. About 3 or 4 cm in length working window is placed at the 4th or 5th ICS in the mid-clavicular line. A last 10 mm port for the thoracoscope is placed at the 5th or 6th ICS in the anterior scapular line.
Results : Level 5 and 6 lymph nodes dissection’s first step is open to the mediastinal pleura between the pherenic and the vagus nerves at the aortopulmonary window level. Attention should be paid to avoid the phrenic nerve and the left recurrent laryngeal nerve injuries. Level 5 lymph nodes are between the lower border of the aortic arch and the upper rim of the left main pulmonary artery. Level 6 lymph nodes are located in the area medial to the ligamentum arteriosum. Level 4 lymph nodes (Left paratracheal lymph nodes) are located between the upper margin of the aortic arch and the upper rim of the left main pulmonary artery. These nodes are also close to the left recurrent laryngeal nerve, so attention should be paid to avoid nerve injury. Level 7 lymph nodes (Subcarinal lymph nodes) are a little more difficult to expose, so a right-sided double-lumen endotracheal intubation is necessary to facilitate the elevation of the left main bronchus during dissection. To expose the left subcarinal space, the left main bronchus is anteriorly, the descending aorta and the esophagus are posteriorly retracted with endoscopic devices.
Conclusion : Standard left-side VATS mediastinal lymph node dissection can provide accurate pathologic staging and better local control.
Methods : The first port is placed at the 7th or 8th intercostal space(ICS) in the mid-axillary line. About 3 or 4 cm in length working window is placed at the 4th or 5th ICS in the mid-clavicular line. A last 10 mm port for the thoracoscope is placed at the 5th or 6th ICS in the anterior scapular line.
Results : Level 5 and 6 lymph nodes dissection’s first step is open to the mediastinal pleura between the pherenic and the vagus nerves at the aortopulmonary window level. Attention should be paid to avoid the phrenic nerve and the left recurrent laryngeal nerve injuries. Level 5 lymph nodes are between the lower border of the aortic arch and the upper rim of the left main pulmonary artery. Level 6 lymph nodes are located in the area medial to the ligamentum arteriosum. Level 4 lymph nodes (Left paratracheal lymph nodes) are located between the upper margin of the aortic arch and the upper rim of the left main pulmonary artery. These nodes are also close to the left recurrent laryngeal nerve, so attention should be paid to avoid nerve injury. Level 7 lymph nodes (Subcarinal lymph nodes) are a little more difficult to expose, so a right-sided double-lumen endotracheal intubation is necessary to facilitate the elevation of the left main bronchus during dissection. To expose the left subcarinal space, the left main bronchus is anteriorly, the descending aorta and the esophagus are posteriorly retracted with endoscopic devices.
Conclusion : Standard left-side VATS mediastinal lymph node dissection can provide accurate pathologic staging and better local control.
책임저자: Kwhanmien Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
연락처 : Kyung Wook Shin, Tel: 031-787-6255 , E-mail : sinkw80@gmail.com
