VATS Microportal Utility Incision For Mediastinal Lymph Node Biopsy

A 31-year-old woman was referred for investigation of mediastinal lymphadenopathy. A large right-sided paratracheal mass of lymph nodes was identified. Possible approaches included the mediastinoscopy via a cervical incision, right video-assisted thoracic surgery (VATS), or even a subxiphoid approach. Of course, open approaches might also be considered by some surgeons.

A very straightforward approach is a two-port operation via incisions slightly smaller than 1 cm, through which conventional VATS instruments can be passed. These incisions also allow for the removal of good-sized whole lymph nodes.

In this type of case, it is important to stay posterior to the phrenic nerve, to only grasp the lymph node at its edge or very gently so as to avoid crushing the tissues, and to pay attention to hemostasis.

The authors are generous with preoperative local and regional anesthetic, and increasingly they perform a serratus regional anesthetic block prior to any incision being made. The authors also place copious local anesthetic before incisions and just prior to skin closure.

The patient left the hospital the day after the operation with no pain on simple analgesics, and she was able to start her chemotherapy very soon after.