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Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA)

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The Transcervical Approach in Thoracic Surgery

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.

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Authors and Affiliations

  1. Klinik für Thoraxchirurgie, Katholisches Klinikum Koblenz, Virchowstraße 7, Koblenz, 56073, Germany

    Biruta Witte MD, Michael Wolf MD & Martin Hürtgen MD, PhD

Authors
  1. Biruta Witte MD
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  2. Michael Wolf MD
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  3. Martin Hürtgen MD, PhD
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Correspondence to Biruta Witte MD .

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Editors and Affiliations

  1. Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland

    Marcin Zieliński

  2. Thoracic Surgery Service, University Hospital Mutua Terrassa, Terrassa, Spain

    Ramón Rami-Porta

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Witte, B., Wolf, M., Hürtgen, M. (2014). Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA). In: Zieliński, M., Rami-Porta, R. (eds) The Transcervical Approach in Thoracic Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54565-8_9

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  • DOI: https://doi.org/10.1007/978-3-642-54565-8_9

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