Diagnostic role of videothoracoscopy in mediastinal diseases

In order to assess the role of videothoracoscopy in the diagnosis of mediastinal diseases, we report a retrospective analysis of 52 cases of mediastinal biopsy performed with this technique.

Between January 1992 and December 1996 52 patients (39 men and 13 women, mean age 53 +/- 29 years) with mediastinal lesions were referred to our department for videothoracoscopic biopsy. There were eight lesions in the anterior mediastinum, while the remaining 44 were in the middle (25 right and 19 left). The adenopathies were solitary or located in positions not within reach of the mediastinoscope, or combined with pulmonary nodules or diffuse pulmonary diseases.

The procedure was performed from the right side in 30 cases and from the left side in 22. In nine cases the complete excision of the mass was achieved. In the eight patients with pulmonary disease a wedge resection was carried out at the same time. Diagnosis was achieved in all cases of mediastinal and lung disease (100%). No conversion to open thoracotomy and no intraoperative complications occurred. The mean hospital stay after surgery was 2.3 +/- 1.3 days in the 49 (94.2%) patients with no complications. The postoperative complications consisted of one case of fatal pulmonary embolism and two cases of prolonged air leak. conclusion: This analysis shows that videothoracoscopy is an effective and reliable method of obtaining a diagnosis of solitary unilateral mediastinal lesions or of adenopathies not within reach of the mediastinoscope. In some cases it also allows the complete excision of the mass. If a procedure on the lung such as a wedge resection is needed, it can be performed at the same time. Since this is a strictly unilateral procedure, it cannot be used in routine preoperative lung cancer staging.