Video-assisted mediastinoscopy: experience from 240 consecutive cases

Background We report our experience with video-assisted mediastinoscopy. Methods We retrospectively reviewed clinical records of all patients who underwent video-assisted mediastinoscopy in a 26-month period. Video-assisted mediastinoscopy was performed in the presence of enlarged lymph nodes (short axis > 1 cm) found at computed tomography scan. Data about operative time, node stations sampled, number of biopsies, and operative complications were collected. Results of the pathologic examination were recorded, as well as (when different) the definitive diagnosis. Results Video-assisted mediastinoscopy was performed in 240 consecutive patients. In 2 patients, the technique was employed for resection of a mesothelial cyst. In the other cases, it was used for diagnosis of enlarged nodes or staging of lung cancer. Mean number of biopsies was 6.0; mean number of sampled nodal stations was 2.3. Mean operative time was 36.6 minutes. Two operative complications occurred: a pneumothorax not requiring drainage and an injury to the innominate artery requiring manubrial split and suture. In 192 patients, the definitive diagnosis was lung cancer (18 small–cell lung cancers). In the remaining 46 patients, video-assisted mediastinoscopy allowed establishment of the diagnosis (sarcoidosis, N = 22; reactive hyperplastic lympho-adenitis, N = 13; tuberculosis, N = 4; involvement by malignancies other than lung cancer, N = 7). Among the 174 patients with non–small cell lung cancer, mediastinal nodal involvement was recognized in 107 cases (N3, N = 28; N2, N = 79). Sixty-seven patients were staged N less than 2; 47 underwent thoracotomy. Postthoracotomy staging agreed with video-assisted mediastinoscopy staging in 44 cases (93.6%). Conclusions Video-assisted mediastinoscopy proved to be safe and effective in nodal assessment of the mediastinum.