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Multimodality dissection in dealing with benign hilar or interlobar lymphadenopathy during video-assisted thoracoscopic surgery lobectomy.

BACKGROUND
Anatomic lung resection by video-assisted thoracoscopic surgery (VATS) has become more and more popular for both malignant and benign pulmonary diseases. However, the existence of hilar or interlobar lymphadenopathy is sometimes technique demanding for surgeons.


METHODS
We'd like to illustrate our strategy in troubleshooting severe hilar and interlobar lymphadenopathy via a video demo. Multimodality was used to troubleshooting those peri-arterial/peri-bronchial lymph nodes, such as electrocoagulation hook, harmonic scalpel, and sharp dissecting using scissors.


RESULTS
This video shows a classic three portal VATS right upper lobectomy, which was complicated with severe hilar and interlobar lymphadenopathy. The operation went through smoothly. The postoperative course of the patient was uneventful.


CONCLUSIONS
When severe hilar or interlobar lymphadenopathy was encountered, multimodality should be taken into account to troubleshooting such a complicated VATS lobectomy.