Table Of ContentThe Transcervical
Approach in
Thoracic Surgery
Marcin Zieliński
Ramón Rami-Porta
Editors
123
The Transcervical Approach
in Thoracic Surgery
ń
Marcin Zieli ski (cid:129) Ramón Rami-Porta
Editors
The Transcervical
Approach in Thoracic
Surgery
Editors
Marcin Zieliński, MD, PhD Ramón Rami-Porta, MD, PhD, FETCS
Department of Thoracic Surgery Department of Thoracic Surgery
Pulmonary Hospital Hospital Universitari Mutua Terrassa
Zakopane Terrassa
Poland Barcelona
Spain
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To my wife Beata and my daughters Aleksandra and Zofi a.
Marcin Zieliński
To my mother, Joaquina, and my departed father, Ramón,
without whom I would be no one.
To Drs. Antonio Alix Trueba and Félix Serrano Muñoz, from
whom I learnt mediastinoscopy and mediastinotomy,
procedures that proved to be fundamental in the development of
my professional life.
To the late Dr. Tsuguo Naruke, for his example, teachings and
mentorship.
With much appreciation and personal esteem.
Ramón Rami-Porta
Forewo rd
The protection afforded by the bony structures surrounding the thorax
deterred surgeons and assailants alike! It is no surprise therefore that “access”
remains an important topic in thoracic surgery. The editors of this book have
brought together expert authors from around the world who share a common
interest and experience in exploiting access to the thorax through the “sky-
light” provided by the thoracic inlet. This book provides comprehensive cov-
erage of established and developing techniques to enable diagnosis, staging
and treatment of intrathoracic disorders using the transcervical approach,
alone and in combination with accessory techniques.
T he chapters detailing diagnostic and staging procedures cover long-e stablished
techniques such as scalene node biopsy and cervical mediastinoscopy and the spin-
off derivatives resulting from improvements in endoscopic instruments and video
assistance which allow more extensive evaluation of mediastinal nodal spread and
the pleural spaces. The array of abbreviations and acronyms, CMT, CITES,
C-VATS, NOTES, MUS, VAMLA and TEMLA, some familiar others new,
include many techniques developed by the authors themselves. Some are comple-
mentary or competitive to others, and comparison is facilitated by each chapter
having a common template which includes the history, indications and contraindi-
cations, results and complications of each, along with a thorough description of the
technique and its variations, complemented by extensive illustrations.
Additional chapters cover therapeutic applications; some such as oesophageal
operations and airway surgery are well established, whilst others such a lobec-
tomy through a cervical approach are in early development. Finally, we are
treated to a glimpse of the future with chapters on robotic surgery and the possible
place for minimal access cervical approaches for cardiovascular procedures.
I am sure the reader will appreciate this thorough review of all things
which can now be achieved through a cervical approach and those that might
be feasible in the near future, written as it is by renowned experts in the fi eld.
Peter Goldstraw
Emeritus Professor of Thoracic Surgery,
National Heart and Lung Institute, Imperial College, London, UK
Honorary Consultant in Thoracic Surgery,
Royal Brompton Hospital, London, UK
Immediate Past President,
International Association for the Study of Lung Cancer
London, UK
vii
Preface
The book that you have in your hands is the result of a process that began in
July 2011, when Marcin and I met in Amsterdam to attend the World
Conference on Lung Cancer. We happened to sit together at the speakers’
dinner, and almost at the end, over dessert and coffee, we talked about the
possibility of editing a book that should include the state of the art of the
thoracic surgery procedures performed through a cervical incision. Both had
experience in the transcervical approach. Marcin, with different teams of co-
workers, had performed the transcervical approach for thymectomy that led
them to the transcervical extended mediastinal lymphadenectomy and, even-
tually, to even transcervical lobectomy; and I and my team had worked on
mediastinoscopy and its variants for many years. We knew that we were not
alone and that there were others who shared a similar interest in this approach.
We were not the fi rst either, because the use of the transcervical approach can
be traced back to the late nineteenth century and to the beginning of the twen-
tieth, especially with Sauerbruch, who is credited for using the transcervical
approach for thymectomy for the fi rst time. Months later, the fi rst draft of the
table of contents was completed, and after several revisions, we believe that
it now includes all the procedures and authors that are presently working on
the transcervical approach.
The Transcervical Approach in Thoracic Surgery covers all diagnostic,
staging and therapeutic procedures performed today. They are varied, and
therefore, the book is divided in fi ve parts. Part I includes ten chapters that
deal with the diagnostic and staging procedures, from the most modest, such
as the scalene fat pad biopsy, to the most thorough: transcervical extended
mediastinal lymphadenectomy. There are many procedures in between
(mediastinoscopy, extended cervical mediastinoscopy, remediastinoscopy,
the different forms of mediastino-thoracoscopy, mediastinal ultrasonography
and video-assisted mediastinoscopic lymphadenectomy) that are performed
for specifi c indications but that provide access to the mediastinum and pleural
spaces from a small cervical incision. Part II deals with the procedures per-
formed to access the thymus and cystic and tumour lesions in the supero-
anterior mediastinum. Part III describes exceptional procedures, such as
transcervical lobectomy and transcervical closure of the main bronchi. These
procedures have proved to be feasible and successful if indicated properly.
Part IV is devoted to the procedures for tracheal and oesophageal lesions.
Finally, Part V covers the application of robotics through the transcervical
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