Mediastinal Lymphadenectomy Periprocedural Care

Updated: Nov 17, 2016
  • Author: R James Koness, MD, FACS; Chief Editor: Erik D Schraga, MD  more...
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Periprocedural Care

Patient Preparation

Anesthesia

Mediastinal lymphadenectomy is performed under general anesthesia using a double-lumen endobronchial tube followed by confirmation of correct positioning with a fiberoptic bronchoscope. To facilitate visualization, the lung on the operative side is deflated during resection and mediastinal lymph node dissection.

Positioning

Standard lateral positioning is employed for a posterolateral, anterior axillary, or limited thoracotomy. The incision is located for a pleural entry through the fourth intercostal space. In patients with right-lung cancer, it is possible to perform a dissection of potentially involved left contralateral tracheobronchial lymph nodes combined with a complete dissection of the right ipsilateral mediastinal lymph nodes. In patients with left-lung cancer, however, contralateral right mediastinal lymph nodes cannot be adequately sampled, because of anatomic constraints imposed by the aortic arch.