Major Complications of Videomediastinoscopy and their Resolution - a 5 year experience

Videomediastinoscopy is an invasive procedure for mediastinal assessment, with low rates of morbidity and mortality. Despite the low risk of complications, they can be potentially lethal if not immediately controlled.

The goal of this study is to analyse the overall incidence of complications of videomediastinoscopies, performed in the last 5 years at our department, as well as their resolution and outcomes.

A retrospective review of all videomediastinoscopies performed at a single institution during a 5-year period was performed. Major complications were defined as life-threatening events.

During the study period, from July 2012 to July 2017, were performed 160 mediastinoscopies, 67 were diagnostic and 93 for staging. There were 3 major complications (1.87%), of which a severe haemorrhage from a bronchial artery, a tracheal rupture, and a massive haemorrhage from an innominate artery laceration. In this 3 cases, the diagnosis were lung cancer in 2 patients and lymphoma in the other one. There were no intraoperative deaths. One patient died in the postoperative period due to mediastinitis and disease progression. The patient who suffered innominate artery laceration, had a stroke due to dissection of the right carotid artery. During follow-up, one patient died from progression of oncologic disease, and the other one is alive 4 years later.

Although mediastinoscopy has a low rate of complications, these can be potentially lethal and the thoracic surgeon should be able to resolve them rapidly. Due to the scarcity of publications on this subject, it is important to describe potential complications of this surgical procedure and their clinical resolution.