Exact pretherapeutic lymph node staging of lung cancer is of special importance for selecting patients for neoadjuvant therapy or for video-assisted thoracoscopic resection. Staging is usually performed by computerized tomography scan and mediastinoscopy. However, these methods do not reach the accuracy of open nodal dissection. Therefore, we developed a technique of radical video-assisted mediastinoscopic lymphadenectomy (VAMLA). In a prospective study, all VAMLA procedures were documented. Lymph nodes were counted and compared to open lymphadenectomy. In 40/46 patients, radical paratracheal and subcarinal dissection was achieved by VAMLA. An average number of 20.7 (5-60, SD 11.1) nodes was gained. This is comparable to our data from open lymphadenectomy.