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Ann Thorac Surg 1994;57:992-995
© 1994 The Society of Thoracic Surgeons

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Articles

Comparative merits of thoracoscopy, mediastinoscopy, and mediastinotomy for mediastinal biopsy

Departments of Thoracic Surgery, Pathology, and Hematology, University "La Sapienza" Rome, Rome, Italy

Accepted for publication August 6, 1993.

^_* Address reprint requests to Dr Rendina, Cattedra di Chirurgia Toracica, 11 Clinica Chirurgica, Universita' "La Sapienza" Roma, Paliclinico Umberto 1, 00161 Rome, Italy.

Between April 1992 and April 1993, we performed fiftyfour mediastinal biopsies in 51 patients with a mediastinal mass. Nine of these had lung cancer with mediastinal lymphadenopathy, and the remaining 42 had various primary mediastinal lesions. We have performed twenty video-assisted thoracic surgical procedure, twenty-six mediastmoscopies, and eight anterior mediastinotomies. In 3 patients the diagnosis was not obtained by mediastinoscopy, and video-assisted thoracoscopy was performed. We conclude that mediastinoscopy is indicated for the majority of lesions involving the peritracheal space. Restating of lymphoma and highly infiltrative lesions are better managed by video-assisted thoracic surgery. Anterior mediastinotomy is indicated when feasible under local anesthesia for tumors infiltrating the anterior chest wall. In all other cases video-assisted thoracic surgery is preferable because it allows removal of large tissue biopsy specimens and even resection with wide surgical exposure and low operative trauma.

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