Thoracoscopic diagnosis and treatment of mediastinal masses. Usefulness of the Two Windows Method

We report on the usefulness of thoracoscopic surgery by the Two Windows Method in mediastinal diseases. While the positioning of the two-window skin incisions was originally decided for lung cancer, but we have been using precisely the same method to biopsy and remove mediastinal lesions.

Thoracoscopic surgery by the Two Windows Method was performed in 40 cases in which it had been impossible to make a diagnosis by noninvasive methods. Access to the pleural cavity was achieved by making skin incisions in two places anterior and posterior to the inferior angle of the scapula in the fourth intercostal space.

Biopsy was performed in 17 of the 40 patients to make a histological diagnosis. It was possible to make a definitive histological diagnosis in all of the patients. Complete resection of a mediastinal tumor was performed in 23 patients, and the resection was concluded thoracoscopically by the Two Windows Method in 22 of these patients (95.7%), with the only exception of one patient in whom we converted to standard thoracotomy because of intraoperative bleeding. There were no postoperative complications and no perioperative deaths.

We conclude that the Two Windows Method is also useful for the diagnosis and complete resection of mediastinal diseases and that this is a low-invasive and safe method.