The mediastinal endodissector is then assembled and inserted into the upper mediastinum. This instrument features a tissue dilator at the tip, a 15-degree Hopkins fiberoptic device and a working channel for one 5-mm laparoscopic instrument. The tissue dilator is anatomically designed so that it can "ride" on the esophageal surface and opens an anterograde dissection space of 2-3 cm in the mediastinum. The tissue dilator of the mediastinoscope can be freely rotated 360 degrees. For full operation, the mediastinoscope is connected to a video camera, a xenon light source, and a flushing/suction device.
It is normal that the first steps of endoscopic dissection of the retrotracheal space are difficult due to the limited initial vision and the anatomical narrowing of the thoracic inlet. Microinstruments such as scissors, forceps or a coagulation/suction instrument as well as ultrasonic shears can be used through the working channel of the medi-astinoscope.
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