Uniportal VATS mediastinal lymphadenectomy right

Incision of approximately 4 cm in length in the area of the anterior axillary line at the upper edge of the 5th rib to access the overlying 4th intercostal space. As a guide, an imaginary line from the tip of the scapula to the nipple is often helpful here. Transection of the subcutis on the rib with the monopolar knife. Subsequently, stepwise preparation of the intercostal muscles with the monopolar knife. The pleura is opened bluntly with a finger. Palpation of the thoracic wall for adhesions and insertion of a wound protection film.

Initially, the exploration of the thorax is performed for macroscopically suspicious lesions and adhesions.

The mediastinal pleura is sharply incised between the azygos vein and the anterior trunk of the pulmonary artery.

Continue the resection of the mediastinal pleura cranially along the superior vena cava up to the origin of the anonyma vein (= brachiocephalic vein).

Now the lymph nodes can be removed as a package between the anterior trunk, the trachea, the pericardium, and the superior vena cava using an ultrasonic scalpel.

Note: The phrenic nerve must be explicitly protected from thermal damage. In left-sided operations, attention must be paid to the course of the recurrent laryngeal nerve in the area of station 2L to also protect it from thermal damage.