Technique and Application of Transcervical Extended Mediastinal Lymphadenectomy in Thoracic Surgery

Extent of removal of the mediastinal nodes during TEMLA. n. = nerve; PA = pulmonary artery; TEMLA = transcervical extended mediastinal lymphadenectomy.

The view of the position of the members of the operating team.

Dissection of the right laryngeal recurrent nerve. a. = artery; n. = nerve.

Dissection of the left laryngeal recurrent nerve. To expose the nerve, the vascularized fascial layers covering the nerve must be divided. a. = artery; n. = nerve.

Dissection of the highest mediastinal nodes (station 1). a. = artery; n. = nerve; v. = vein.

Dissection of the lower paratracheal nodes (station 4R) from the ascending aorta, the azygos vein, the trachea, and the right main bronchus. SVC = superior vena cava; v. = vein.

Dissection and removal of the left lower paratracheal nodes (station 4L). n. = nerve.

View of the subcarinal region after removal of the subcarinal (station 7) and the periesophageal (station 8 nodes). a. = artery; SVC = superior vena cava; v. = vein.

Entrance to the left para-aortic space containing the para-aortic (station 6) and the aorta-pulmonary window (station 5) nodes. n. = nerve; v. = vein.

View of the aorta-pulmonary window area after dissection of the station 5 and station 6 nodes. a. = artery; n. = nerve; v. = vein.

Dissection of the prevascular (station 3A). SVC = superior vena cava; v. = vein.