The thoracoscope as diagnostic tool for solid mediastinal masses

Despite the accuracy of percutaneous biopsy of mediastinal masses under CT scan or sonographic control, there is still a need for surgical biopsy because of difficult location or because of insufficiency of the percutaneous biopsy, especially for those tumors requiring an immunological classification.

The thoracoscopic approach to mediastinal masses is an alternative to the usual surgical biopsies performed through thoracotomy, sternotomy, or anterior mediastinotomy. The procedure is performed under general anesthesia and one-lung ventilation.

In a series of 47 cases, a histological diagnosis was obtained in 44 cases (93.6%). There was one hemorrhagic complication requiring thoracotomy (2.1%). The mean postoperative duration of stay was 3.2 days.

Thoracoscopy is the method of choice in case of failure or contraindication of percutaneous biopsy. There is still a role for mediastinoscopy in treating paratracheal lymph nodes.