Procedure

Transcervical extended mediastinal lymphadenectomy

Marcin Zieliski^a,d,*, Jarosaw Kuda^a, Tomasz Nabiaek^b, ukasz Hauer^a, Juliusz Pankowski^c and Bogdan Dziadzio^d

^a Department of Thoracic Surgery, Pulmonary Hospital in Zakopane, ul. Gadkie 1, 34-500 Zakopane, Poland
^b Department of Anesthesiology and Intensive Care, Pulmonary Hospital in Zakopane, ul. Gadkie 1, 34-500 Zakopane, Poland
^c Department of Pathology, Pulmonary Hospital in Zakopane, ul. Gadkie 1, 34-500 Zakopane, Poland
^d ul.Ubocz 22, 34-500 Zakopane, Poland

^* Corresponding author: ^* Tel.: +48 18 2015045. E-mail: marcinz{at}mp.pl

Transcervical extended mediastinal lymphadenectomy (TEMLA) is a new procedure for bilateral excision of all nodal stations of the mediastinum, except for the pulmonary ligament nodes (station 9) and the most distal left lower paratracheal nodes (station 4L). The procedure is performed through a transverse 5–8 cm incision in the neck with elevation of the sternum with a traction device facilitating the access to the mediastinum. Most of the procedure is performed with an open technique, while the removal of the subcarinal (station 7) and periesophageal nodes (station 8) is performed with the mediastinoscopy assisted technique and excision of the paraaortic nodes (station 6), the aorta-pulmonary window nodes (station 5) and, sometimes, the prevascular nodes (station 3A) is performed with the aid of a videothoracoscope introduced to the mediastinum through the neck incision, without violating the pleura.

Key Words: Lung cancer • Mediastinum • Neoplasm staging • Lymph node excision