Technical Pitfalls of Transcervical Extended Mediastinal Lymphadenectomy-How to Avoid Them and to Manage Intraoperative Complications

Transcervical extended mediastinal lymphadenectomy (TEMLA), introduced by our team in 2004, is a new technique for the preoperative staging of non-small cell lung cancer (NSCLC). The aim of TEMLA is to maximally accurately stage and possibly to improve late results of treatment of NSCLC. Operative techniques include a collar incision in the neck, elevation of the sternal manubrium with a special retractor, bilateral visualization of the laryngeal recurrent and vagus nerves, and dissection of all mediastinal nodal stations except for the pulmonary ligaments nodes (station 9, according to the Mountain-Dresler map). Generally, the mediastinal pleura are not violated, and no drain is left in the mediastinum. In this article, some important steps the facilitating safe and straightforward performance of TEMLA are presented, and methods of managing intraoperative complications is discussed.