We report a new technique involving the ''Secrea (HOGY TM )'' sponge spacer for right superior mediastinal node dissection for the treatment of lung cancer. This technique allows the surgeon to make space within the operative field. The ''Secrea'' makes the operation safer and reduces some of the technical difficulties associated with thoracoscopic surgery.
Video-assisted thoracic surgery (VATS) has become much more common over the last decade. VATS results in less postoperative pain and a shorter period of hospitalization. We introduce the ''Secrea'' sponge spacer, which is elliptic-cylindrical in shape and is made of polyurethanic material (Fig. 1A). The Secrea comes in three sizes, which measure 60 mm along the major axis  35 mm along the minor axis  20 mm in height, 50 mm  30 mm  15 mm, and 40 mm  25 mm  15 mm, respectively. The Secrea can be held with forceps and introduced into the thoracic cavity through a 12-mm trocar. It contains a non-X-ray penetrative string and a radiopaque marker, and it also remains heat-resistant at temperatures above 4008C. Its function is (1) to absorb fluid, (2) to allow fluid to be sucked through the moist Secrea, (3) to allow the adjacent fragile tissue to be pressed softly without adhering to it, and (4) to prevent electric scalpels and ultrasonic coagulating shears inflicting secondary injuries on organs and tissues. The Secrea endoscopic surgical spacer, which was codeveloped with Hogy Medical Co. Ltd, has already been used for laparoscopic surgery [1]. Before its present clinical application to thoracoscopic surgery, we performed several preliminary experiments using swine. The effectiveness of the Secrea was confirmed, as it allowed us to expose the great vessels and trachea easily via its placement under the vessels. In addition, we have subsequently found that it is also applicable to thoracoscopic surgery. The Secrea enabled us to make space in the operative field without the aid of an assistant during the dissection of the right superior mediastinal nodes. Below, we introduce a new thoracoscopic surgical technique involving the ''Secrea'' sponge spacer.