CHAPTER 20 Video-Assisted Mediastinoscopy—Video 20
Approach to Video-Assisted Mediastinoscopy
Video-Assisted Mediastinoscopy
Step 1. Incision
♦ Make a 2-cm incision (Figure 20-1) transversely in the base of the neck that is 1 or 2 fingerbreadths above the sternal notch.
♦ With electrocautery, cut transversely through the platysma muscle and then vertically in the midline between the strap muscles.
♦ With a closed Kelly clamp, bluntly dissect in the midline between the muscles to expose the trachea.
♦ The finger breaks through the pretracheal fascia to mobilize the lymph nodes as much as possible. This often is the safest method to dissect matted nodes away from vessels.
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