What is video-assisted thoracoscopic surgery (VATS) mediastinal lymphadenectomy?

Updated: Feb 16, 2021
  • Author: R James Koness, MD, FACS; Chief Editor: Erik D Schraga, MD  more...
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There is growing acceptance of video-assisted thoracoscopic surgery (VATS) in the surgical treatment of early-stage lung cancer. The difficulty in performing a mediastinal lymphadenectomy thoracoscopically may affect the continued use of this procedure. The statement made by Robert Ginsberg in 1997 remains true today: “The addition of mediastinal lymph node dissection produces the best possible surgical and pathologic staging of lymph node disease but has yet to be proven more efficacious as a curative procedure.” [4]

Complete mediastinal lymphadenectomy will continue to be performed in medical centers demanding the most comprehensive information. This is justified by previous data demonstrating that the dissection can be performed with minimal time and no increase in morbidity and mortality.

For centers pursuing minimally invasive techniques, VATS mediastinal lymph node staging and video-assisted mediastinal lymphadenectomy (VAMLA) are clinically feasible procedures with accurately staging and acceptable complication rate. Academic medical centers with the infrastructure and experience will provide the data needed validate the application of noninvasive techniques to optimally stage and ultimately treat patients with NSCLC.

Transcervical extended mediastinal lymphadenectomy (TEMLA) is another approach that has been the subject of increasing interest. [5, 6]

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