Video-assisted mediastinoscopy as a therapeutic tool

Surg Endosc. 2009 Nov;23(11):2466-72. doi: 10.1007/s00464-009-0418-2. Epub 2009 Apr 3.


Background: Video-assisted mediastinoscopy (VAM) is a well-known method for surgical exploration of superior retrovascular mediastinal disease and for determining the staging of lung cancer. This study aimed to report the authors' experience using VAM therapeutically.

Methods: Between 1998 and 2007, 765 patients had VAM in the authors' service. For 742 of these patients, VAM was used to diagnose or stage a disease. The remaining 23 patients (3%) had VAM as a therapeutic procedure. Two groups of patients were studied: those who had VAM alone and those who had VAM associated with another procedure. These studies focused on indications, results, and specific morbidity and mortality.

Results: The VAM alone group (14 patients) underwent mediastinal lymphadenectomy for thyroid cancer (mean number of lymph nodes/positives, 16/6) (n = 4), closure of the left post-pneumonectomy bronchopleural fistula (n = 3), mediastinal cyst resection (n = 5), ectopic hyperfunctioning parathyroid resection (n = 1), and mediastinal hematoma evacuation (n = 1). This group had an operative time of 40 to 160 min and a hospital stay of 2 to 10 days. The group that had VAM associated with another approach (9 patients) had VAM during transhiatal esophagectomy for cancer (mean number of lymph nodes, 8) (n = 7), VAM combined with video-assisted thoracoscopic surgery (n = 1), and minithoracotomy for masses in the aortopulmonary window (unique metastasis from melanoma or thyroid cancer) (n = 1). This group had an operative time of 60 to 135 min and a hospital stay of 7 to 52 days. No specific mortality or morbidity occurred. Meanwhile, three patients died: two after bronchopleural fistula (respiratory insufficiency, severe sepsis) and one because of liver insufficiency. Two patients experienced myocardial ischemia or pneumonia after transhiatal esophagectomy.

Conclusions: "Exploratory" VAM for mediastinal disease is an important training tool that can be applied further for a therapeutic purpose. The authors' experience has shown its potential. Its surgical indications and benefits deserve better identification.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / mortality
  • Lung Neoplasms / surgery
  • Lymph Node Excision / methods*
  • Male
  • Mediastinal Neoplasms / diagnosis
  • Mediastinal Neoplasms / mortality
  • Mediastinal Neoplasms / surgery*
  • Mediastinoscopy / methods*
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods
  • Neoplasm Staging / methods
  • Retrospective Studies
  • Survival Analysis
  • Thoracic Neoplasms / diagnosis
  • Thoracic Neoplasms / mortality
  • Thoracic Neoplasms / surgery*
  • Thoracic Surgery, Video-Assisted / methods*
  • Treatment Outcome