Thoracoscopic mediastinal lymph node dissection: an experimental study in pigs

Thoracoscopic lobectomy is feasible and can be performed correctly in terms of anatomy. Its application in bronchial carcinoma is often criticized, partly because of incomplete mediastinal lymph node dissection (MLD). We therefore developed the technique and studied the completeness of MLD in an animal experiment. Ten pigs were anesthetized and intubated with a double-lumen tube and the left lung was excluded from ventilation. Four trocars were inserted. Using a modified endo-Babcock clamp for traction we resected all ipsilateral tracheobronchial, pretracheal and paratracheal and paraesophageal lymph nodes (LNs) as well as nodes in the aortopulmonary window. An average of 19 +/- 5 mediastinal LNs were removed. Macroscopic control through a thoracotomy did not show any residual LNs at the site of operation. Complete resection of all ipsilateral LNs in the paratracheal and paraesophageal region as well as the aortopulmonary window can be performed thoracoscopically in pigs. This may offer further perspectives in the thoracoscopic treatment of bronchial carcinoma.