Tips on lymph node dissection using energy devices: a narrative review

Objective: To clarify the current status of lymphadenectomy using energy device in thoracic surgery with focus on key questions such as (I) extent of lymph node dissection (LND), (II) specific characteristics of energy devices, (III) surgical techniques and methods to prevent complications. Background: LND is a crucial factor for the staging and treatment of lung cancer. In parallel with the introduction of minimally-invasive approaches for the surgical treatment of lung diseases, new tools have also been implemented in the field, including energy devices. Although the adequate method for LND is still under debate, it is expected that an extensive LND leads to a more accurate nodal staging and better survival. Methods: We ran a research in MEDLINE (via PubMed) in July 2021 and dealt with any studies of interest. We included manuscripts focusing on LND or lymphadenectomy in thoracic surgery, including details on usage of energy device if possible. Conclusions: The use of energy devices during LND is theoretically beneficial because of their sealing effect, curved rotating tip, and ability to decrease complications. A correct understanding of energy devicerelated features and anatomical structures is essential for its effective use and prevention of unexpected injuries. The use of energy device in thoracic surgery has crossed a tipping point and has been extensively implemented. Further concrete evidence comparing the benefits of energy devices are awaited.