Uniportal video-assisted thoracic surgery lymph node dissection: surgical technique

: Mediastinal and hilar lymph node dissection is recommended during anatomical pulmonary resection in patients with non-small cell lung cancer (NSCLC). In case of early-stage NSCLC, video-assisted thoracic surgery (VATS) approach has became the preferred approach and has been associated with equivalent oncological outcomes in terms of lymph node dissection, and with decreased morbidity in comparison to standard thoracotomy. Recently, pulmonary segmentectomy has been reported with similar recurrence and survival rates in comparison with lobectomy in patients with small (diameter <2 cm), peripheral tumors when adequate surgical margins are obtained, and systematic lymph node dissection is performed. Thus, radical lymph node dissection is an important part of surgical management of NSCLC patients. Uniportal VATS (UVATS) approach has progressively gained acceptance for anatomical resections, but concern remains regarding the adequacy and the standardization of the lymphadenectomy. This approach requires specific instruments and exposure to achieve complete mediastinal lymph node dissection. We have successfully introduced the UVATS approach for all types of anatomical pulmonary resection and mediastinal lymph node dissection. In this paper, we describe the standardization of our approach for left- and right-sided systematic mediastinal lymph node dissection performed during UVATS anatomical pulmonary resections. We focus on the patient's positionning, the surgical material, the incision placement, and exposure tips for en-bloc resection of different lymph node stations.