Abstracts 23rd European Conference on General ...

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of the small artery which runs parallel to a middle cardiac branch. Near 4L, ... fully dissect 4L the operator may have to sever part of the cardiac plexus as.
Interactive CardioVascular and Thoracic Surgery

Abstracts 23rd European Conference on General Thoracic Surgery 31 May–3 June 2015, Lisbon, Portugal V-011 THORACOSCOPIC DISSECTION OF STATIONS 2R AND 4L TO MINIMIZE THE RISK OF RECURRENT LARYNGEAL NERVE INJURY Wataru Nishio, K. Tane, K. Uchino, M. Yoshimura Chest Surgery, Hyogo Cancer Centre, Akashi, Japan Objectives: Dissection of station 2R or station 4L is essential in the complete resection of upper lobe lung cancer but tends to be insufficient for fear of damaging the recurrent laryngeal nerves by tugging or electrocautery. Improvements in thoracoscopy and the visibility of minute anatomy by magnified vision allow for precise lymph node dissection. We present a surgical technique for thoracoscopic dissection of 2R and 4L. Video description: A 4-port thoracoscopy is used. Ultrasonic coagulation and incision apparatus on low output to avoid thermal damage during perineural dissection is preferred. From the vagal nerves, the recurrent laryngeal nerves and middle cardiac branches form a common stem. Severing the latter at the immediate periphery of the bifurcation exposes the recurrent laryngeal nerve

and allows for a top-down dissection of 2R or 4L. Near 2R, care must be taken of the small artery which runs parallel to a middle cardiac branch. Near 4L, the operator should identify the middle cardiac branch stemming from the recurrent laryngeal nerve and sever it after sequentially severing the other sympathetic nerves found descending along the inner edge of the aortic arch. To fully dissect 4L the operator may have to sever part of the cardiac plexus as ittwines around the innermost 4L node. Severing of the ligamentum arteriosus may also be necessary for male patients. From April 2012 to September 2014, 88 cases of 2R and 43 cases of 4L dissection were performed for clinical stage I lung cancer. Five cases of unexpected 2R metastases and no 4L metastases were observed in pathological diagnosis, two of which were skip metastases. Conclusions: Improved visibility of minute anatomy by magnified vision and innovation of surgical techniques allows for mediastinal lymph node dissection with minimal risk of injury to the recurrent laryngeal nerves and with the potential of identifying misdiagnoses by false negatives. Disclosure: No significant relationships.