Para Aortic Lymph Node Dissection

Para-aortic lymph node dissection adjacent to the descending thoracic aorta is typically performed following lung resection when there is suspicion of mediastinal or para-aortic nodal involvement. After achieving adequate exposure, the lung is retracted anteriorly and superiorly to fully visualize the posterior mediastinum. The dissection begins by carefully opening the pleura overlying the descending thoracic aorta, taking care to identify and preserve the vagus nerve and its branches. The fatty lymphatic tissue is mobilized using sharp and blunt dissection while maintaining meticulous hemostasis due to the close proximity of the aorta and intercostal vessels. Lymph nodes are swept en bloc along the aortic surface, following the natural tissue planes, with clips or energy device used for lymphatic channel control to reduce the risk of postoperative chyle leak. The specimen is then removed, and the field is inspected to ensure hemostasis, preservation of vital structures, and confirmation of complete nodal clearance.