Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA): Recipe and Cooking Secrets (a Tutorial)

Abstract

Being a central part in the book of thoracic oncology, correct diagnosis and precise staging of lung cancer is of fundamental interest. As the lung-cancer chapter turned out being more kind of a recipe book of therapeutic possibilities, the list of diagnostic ingredients is not negligible: the various spices consists of different anatomic and metabolic imaging techniques as well as of endoscopies and minimally invasive surgical procedures. Indeed, these staging techniques should be performed well seasoned, that is, sequentially and with an increasing degree of invasiveness. But when it comes to the determination of algorithms on preoperative mediastinal staging, video-assisted mediastinoscopic lymphadenectomy represents indispensably the gold standard when highest accuracy in cytological result is needed. We hereby describe in detail our current operative technique of the video-assisted mediastinoscopic lymphadenectomy procedure, which clarifies its growing up from being just a solely diagnostic and dissection tool to an expert-recognized combined staging and advanced therapeutic tool in the context of minimal invasive lung cancer resection.