TRANSCERVICAL MEDIASTINAL LYMPHADENECTOMY

Transcervical mediastinal lymphadenectomy
the technique of temla has been developed by dr. zielinski in
zakopane, poland. 32–34 this involves a collar incision that's
wider than for a standard mediastinoscopy, followed by dissection
of the right and left carotid and therefore the innominate arteries
and therefore the right and left innominate veins. this mobilization of the
vessels allows them to be moved aside and supplys wonderful exposure
to the entire mediastinum. each of the recurrent nerves
are visualized and fastidiously protected. a whole mediastinal
node surgery is performed, together with nodes on top of the innominate
vein ( level one ), bilateral paratracheal ( a pair of, four ), subcarinal
and periesophageal ( seven, eight ), moreover because the para-aortic nodes ( five, six ).
complications in a veryn expertise of 256 ci to iii patients were
seen in 11% ( together with transient recurrent nerve palsy in a pair of. 3%,
pleural effusion in 4%, pneumothorax in zero. 4% ). 32 a mean of
39 nodes per patient were removed. at thoracotomy, residual
benign nodes were found in 9% and missed malignant nodes in
4%, occurring completely early within their expertise. the sensitivity
of temla for the detection of mediastinal node involvement
is 94%, with a specificity of 100%, fn rate of 3%, and
fp rate of zero. 32 it isn't known at this purpose whether or not alittle
deposit found by such an intensive staging investigation carries
constant poor prognosis as a deposit detected by routine mediastinoscopy.