Radical video-assisted mediastinoscopic lymphadenectomy (VAMLA) – technique and first results

Abstract

Exact pretherapeutic lymph node staging of lung cancer is of special importance for selecting patients for neoadjuvant therapy or for video-assisted thoracoscopic resection. Staging is usually performed by computerized tomography scan and mediastinoscopy. However, these methods do not reach the accuracy of open nodal dissection. Therefore, we developed a technique of radical video-assisted mediastinoscopic lymphadenectomy (VAMLA). In a prospective study, all VAMLA procedures were documented. Lymph nodes were counted and compared to open lymphadenectomy. In 40/46 patients, radical paratracheal and subcarinal dissection was achieved by VAMLA. An average number of 20.7 (5-60, SD 11.1) nodes was gained. This is comparable to our data from open lymphadenectomy.

Pros: should a patient with stage IA non-small cell lung cancer undergo invasive mediastinal staging?

“…The role of transcervical lymphadenectomies in early stage lung cancer has been described, showing better staging values than standard mediastinoscopy and endoscopic ultrasound fine needle aspiration techniques (14)(15)(16)(17)(18). Therefore, in case of central tumours, the accuracy of these techniques adds value to rule out mediastinal disease, enhancing, therefore, clinical staging.…”

“…VAMLA is a totally endoscopic procedure performed with the video mediastinoscope. Its aim is to remove en bloc the lymph nodes and the surrounding fatty tissue of the right and left paratracheal and subcarinal nodal stations (14). TEMLA is a mainly open procedure, more extensive than VAMLA because it also includes the highest mediastinal, subaortic, anterior mediastinal and paraesophageal nodes (15).…”

video mediastinoscopy; university first experience,

“…Primer akciğer kanserinde BT ile mediastende 1 cm'den büyük lenf bezi görüldüğünde mediastinoskopi rutin hale gelmiştir. [1,2] Öte yandan patolojik boyutta lenf bezi görülmediği zaman bile mediastinoskopi yapılması gerekliliği birçok yazar tarafından vurgulanmaktadır. [3,4] Özellikle akciğer kanserinin evrelenmesi için rutindir.…”

“…[5,6] Klasik kitaplarda mediastinoskopinin olası riskleri sebebiyle deneyimli cerrahlar tarafından yapılması gerektiği vurgulanır. [1,3,7] Bu durum sadece yapan kişi tarafından görülebildiği için, mediastinoskopi sırasın-da eğitimi zorlaştırmaktadır [4] Videomediastinoskopi, literatürde güvenli ve etkin bir yöntem olarak bildirilmektedir. [1] Görüntünün ekrana alınması işlemin bütün ameliyat ekibi tarafından izlenmesini sağlar ve deneyimli kişilerin işlemi bizzat yapması gereğini ortadan kaldırır.…”

Transoral endoscopic mediastinal surgery (TOEMS)—results of a first clinical study for scarless mediastinal lymph node biopsies

“…Access to the aortopulmonary window is instead provided by transcervical extended mediastinal lymphadenectomy (TEMLA), which is performed as a mixture of open and mediastinoscopic surgery (5,6). Both methods have a much higher probability to detect mediastinal lymph node metastases compared to conventional mediastinoscopy or VAM (4,7,8). However, the extended procedures are accompanied with a higher rate of complications, which is the reason that their use is currently recommended only for experienced centres and clinical studies (9).…”