Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA)

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Abstract

Video-assisted mediastinoscopic lymphadenectomy (VAMLA) is defined as systematic dissection of the mediastinum via standard cervical mediastinoscopy incision by the means of a spreadable video-mediastinoscope, providing a radicality comparable to open lymphadenectomy. Standard VAMLA dissection comprises the subcarinal and both paratracheal zones. Beyond, the technically feasible range of dissection includes the highest mediastinal, upper paratracheal, and para- and subaortic stations of the mediastinum, the hilar and some of the right-sided interlobar N1 nodes. VAMLA is performed by one surgeon and associated with a median operation time of 54 min and complication rates up to 4 %. Staging by VAMLA is highly accurate (sensitivity, 0.94; specificity, 1.0; false-negative rate, 0.009). VAMLA reduces the necessity of mediastinal reexploration at lung resection to a minimum, thus speeding up especially VATS lobectomies. In combination with left-sided lung resections, VAMLA enables the bilateral dissection of the paratracheal compartments, and combined to right-sided procedures, the dissection of the contralateral paratracheal nodes is facilitated and improved. VAMLA eliminates re-mediastinoscopies after neoadjuvant treatment. VAMLA is contraindicated in the presence of extensive mediastinal disease.

Keywords

Lung Resection Innominate Artery Systematic Nodal Dissection Subcarinal Lymph Node Mediastinal Dissection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Klinik für ThoraxchirurgieKatholisches Klinikum KoblenzKoblenzGermany

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