Ambulatory mediastinoscopy and anterior mediastinotomy

Ambulatory facilities are being used more and more for various diagnostic and therapeutic procedures. We report 158 consecutive mediastinoscopies and anterior mediastinotomies performed in an ambulatory setting from July 1981 to February 1990. There were 120 patients with a malignancy: 114 bronchogenic carcinomas, 4 lymphomas, 1 teratocarcinoma, and 1 carcinoma of the stomach. Thirty-eight patients had a benign condition, including sarcoidosis in 27 and miscellaneous diagnosis in 11. Twenty-two patients (14%) were admitted the same day: 9 for elective operation in view of bed availability, 8 for medical observation, and 5 for overnight admission for nonmedical reasons. Six nonfatal complications were encountered: hemoptysis (2), atrial fibrillation (1), pneumonia (1), mediastinal self-contained bleed (1), and tear of a pulmonary artery (1). There was no operative mortality. Overall, ambulatory mediastinoscopy and anterior mediastinotomy permitted a diagnosis in 47 patients (20%) and confirmed unresectable malignant disease in 29 patients, thus sparing unnecessary admission to a surgical ward in 76 (48%) of the 158 patients. Mediastinoscopy and anterior mediastinotomy can be safely performed in an ambulatory setting and do alleviate the need for hospitalization in a substantial number of patients.