Mediastinal Lymph Node Dissection and Approach to the Fissures

Minimally invasive approaches to anatomical lung resections have become increasingly popular for many thoracic surgical practices. Mediastinal lymph node assessment is a key component in appropriately staging patients with operable early-stage lung malignancy. Detection of radiographic occult nodal metastases depends on adequate surgical lymph node dissection. During robotic-assisted video thoracoscopic surgery, thoracic surgeons can achieve nodal staging equivalent to an open approach without compromising oncologic principles. Thus, adequate detection of occult nodal metastasis can be achieved with robotic-assisted mediastinal lymph node dissection, with some studies suggesting this approach may be superior to standard video-assisted thoracoscopic mediastinal lymph node dissection. In this chapter, we review robotic-assisted approaches to perform mediastinal nodal dissection and fissure dissection in patients with lung cancer.