General thoracic surgeons are faced with challenges thrown at them from time to time. This video demonstrates accessing multiple nodal stations, including a contralateral nodal station. Meticulous study of the computed tomography (CT) scan suggested that the 4L left nodal station was, in fact, not far away from the midline, and an access from a right VATS approach was worked out. The dangers of harvesting 4L nodes are discussed, and what the surgeon should be aware of is highlighted. The author concludes that accurate reading of the CT images makes approaching structures across the midline simpler than might be expected.
