Abstract
Background: Feasibility, completeness, and morbidity of videoscopic-assisted mediastinal lymph node dissection (VATS MLND) were compared to the standard surgical technique in an experimental study.
Methods: Right upper MLND—together with upper lobectomy in half of the cases—was performed in ten large white pigs. Six animals were operated using VATS (group 1), four using conventional open techniques (group 2). After 1 week, the animals were sacrificed and the mediastinum was assessed for remaining lymph nodes.
Results: All animals survived without intra- or post-operative complications. There was no significant difference in the operation time between the two groups (3.2±0.8 vs 3.2±0.2 h). The number of mediastinal lymph nodes harvested was 9.5±2.7 in group 1 and 11.5±0.5 in group 2 (n.s.). The post-mortem assessment of the mediastinum showed in two animals of group 1 and in two animals of group 2 that one lymph node was left behind. In addition, in one animal of group 1 four small retrotracheal lymph nodes were found.
Conclusions: VATS MLND can be accomplished without morbidity and is as radical as that achieved with conventional surgery in the paratracheal and peribronchial areas in this experimental setting. However, retrotracheal lymph node dissection might not be as complete as achieved by conventional surgery.
Similar content being viewed by others
References
American Thoracic Society (1983) Clinical staging of primary lung cancer. Am Rev Respir Dis 127: 659
Boutin C, Viallat JR, Aelony Y (1990) History and evolution of the technique. In: Boutin C (ed) Practical thoracoscopy, vol 3–5, 1st ed. Springer-Verlag, Berlin
Braimbridge MV (1993) The history of thoracoscopic surgery. Ann Thorac Surg 56: 610–614
Burt ME, Pomerantz AH, Bains MS, McCormack PM, Kaiser LR, Hilaris BS, Martini N (1987) Results of surgical treatment of stage III lung cancer invading the mediastinum. Surg Clin North Am 67: 987–1000
Daly BDT, Mueller JD, Faling LJ, Diehl JT, Bankoff MS, Karp DD, Rand WM (1993) N2 lung cancer: outcome in patients with false-negative computed tomographic scans of the chest. J Thorac Cardiovasc Surg 105: 904–911
Greschuna D, Maassen W (1973) Die lymphogenen Absiedelungs wege des Bronchialkarzinoms. Georg Thieme Verlag, Stuttgart
Inderbitzi R, Furrer M, Striffeler H (1992) Die operative Thorakoskopie—Indikationen und Technik. Chirurg 63: 334–341
Inderbitzi R, Furrer M, Striffeler H, Althaus U (1993) Thoracoscopic pleurectomy for treatment of complicated spontaneous pneumothorax. J Thorac Cardiovasc Surg 105: 84–88
Izbicki JR, Thetter O, Kreusser T, Passlick B, Trupka A, Karg O, Wilker DK, Schweiberer L (1991) Der Wert der Computer-tomographie und der chirurgischen Beurteilung für das Lymphknoten-Staging beim Bronchial-carcinom. Chirurg 62: 885–890
Kirby TJ, Rice TW (1993) Thoracoscopic lobectomy. Ann Thorac Surg 56: 784–786
Landreneau RJ, Hazelrigg SR, Mack MJ, Fitzgibbon LF, Dowling RD, Acuff TE, Keenan RJ, Ferson PF (1993) Thoracoscopic mediastinal lymph node sampling: useful for mediastinal lymph node stations inaccessible by cervical mediastinoscopy. J Thorac Cardiovasc Surg 106: 554–558
Lewis R, Caccavale RJ, Sisler GE, Mackenzie JW (1992) One hundred consecutive patients undergoing video-assisted thoracic operations. Ann Thorac Surg 54: 421–426
Martini N, Flehninger BJ, Zaman MB, Beatti EJ (1983) Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node metastases. Ann Surg 198: 386–397
McKenna RJ Jr (1994) Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer. J Thorac Cardiovasc Surg 107: 879–882
Naruke T, Asamura H, Kondo H, Tsuchiya R, Suemasu K (1993) Thoracoscopy for staging of lung cancer. Ann Thorac Surg 56: 661–663
Nohl-Oser HC (1972) An investigation of the anatomy of the lymphatic drainage of the lungs. Ann R Coll Surg Engl 51: 157
Roviaro G, Varoli F, Rebuffat C, Vergani CD, D'Hoore A, Scalambra SM, Maccioco M, Grignani F (1993) Major pulmonary resections: pneumonectomies and lobectomies. Ann Thorac Surg 56: 779–783
Shennib HA, Landreneau R, Mulder DS, Mack M (1993) Videoassisted thoracoscopic wedge resection of T1 lung cancer in high-risk patients. Ann Surg 218: 555–560
Shepherd FA (1993) Induction chemotherapy for locally advanced non-small cell lung cancer. Ann Thorac Surg 55: 1585–1592
Thomas PA, Piantadosi S, Mountain CF (1988) Should subcarinal lymph nodes be routinely examined in patients with non-small cell lung cancer? J Thorac Cardiovasc Surg 95: 883–887
Van Raemdonck DE, Schneider A, Ginsberg RJ (1992) Surgical treatment for higher stage non-small cell lung cancer. Ann Thorac Surg 54: 999–1013
Wain JC (1993) Video-assisted thoracoscopy and the staging of lung cancer. Ann Thorac Surg 56: 776–778
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Furrer, M., Altermatt, H.J., Ris, H.B. et al. Video-assisted mediastinal lymph node dissection assessed in an experimental setting. Surg Endosc 10, 128–132 (1996). https://doi.org/10.1007/BF00188357
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00188357