[The diagnostic value of thoracoscopy in solid masses of the mediastinum]

Despite the accuracy of percutaneous biopsy of mediastinal masses under CT scan or sonographic control, there is still a need for surgical biopsy either because of difficult location or because of insufficiency of the percutaneous biopsy, especially for those of the tumors requiring an immunological classification. The thoracoscopic approach of mediastinal masses is an alternative to the usual surgical biopsies performed through thoracotomy, sternotomy or anterior mediastinotomy. The procedure is performed under general anaesthesia and one-lung ventilation. In a series of 44 cases, an histological diagnosis was obtained in 41 cases (93.1%). There was one haemorrhagic complication requiring thoracotomy (2.3%). The mean post-operative duration of stay was 3.2 days. We conclude that thoracoscopy is the method of choice in case of failure or contraindication of percutaneous biopsy. There is still a role for mediastinoscopy for laterotracheal lymph nodes.