EXPERIENCE WITH THE 2-WINDOWS METHOD FOR MEDIASTINAL LYMPH-NODE DISSECTION IN LUNG-CANCER

Background. Continuing to refine minimally invasive thoracoscopic surg ical procedures, we have established the two-windows method. Methods. Skin incisions required by this method consist of a 2- to 3-cm skin in cision posteriorly, and a 2- to 3-cm skin incision anteriorly in the f ourth intercostal space, with the inferior angle of the scapula as the midpoint. We used this method to perform pulmonary lobectomies in com bination with thoracoscopy and mediastinal lymph node dissection in 10 0 consecutive patients with lung cancer (preoperative diagnosis, stage I, TI NO MO). Results. The mean operative time was 2 hours 46 minutes , the mean blood loss was 68.2 mL, and the mean number of mediastinal lymph nodes dissected was 24.3. In developing this minimally invasive thoracoscopic procedure, which facilitates mediastinal lymph node diss ection, we realized that it is best performed through the fourth inter costal space. Because the tracheal bifurcation can be seen directly be low this level, surgical manipulation in this area can be easily perfo rmed. This enables the same extent of mediastinal lymph node dissectio n as that performed during a standard thoracotomy. Another advantage o f this method is that a standard posterolateral thoracotomy incision c an be made whenever necessary by simply connecting the two incisions. Conclusions. We believe that the two-windows method is capable of serv ing as the standard method for the surgical treatment of stage I lung cancer. (C) 1998 by The Society of Thoracic Surgeons.