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How To Do It

A Cervical Approach to Investigating Pleural Disease

Department of Thoracic Surgery, Nottingham City Hospital, Nottingham, United Kingdom

Accepted for publication October 21, 2008.

^_* Address correspondence to Dr Black, Department of Thoracic Surgery, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, United Kingdom (Email: edwardblack{at}mac.com).

We describe a modern cervical approach to the pleural space using video-mediastinoscopy, which allows both mediastinoscopy and pleuroscopy to be performed simultaneously. Mediastinoscopy is carried out with lymph node sampling, and the pleura are exposed and the pleural cavity is entered under direct vision. A thoracoscope is admitted into the pleural space, where lavage, biopsy, and pleurodesis can be carried out. Fifteen patients underwent mediastino-pleuroscopy to investigate pleural effusion and stage malignancy. One patient underwent bilateral pleuroscopy through a single cervical approach. There were no mortalities and the mean postoperative stay was 2.4 days. Mediastino-pleuroscopy is safe, uses a small incision, is well tolerated, and allows access to both pleura and the mediastinum.