Videothoracoscopy for the management of mediastinal mass lesions.

BACKGROUND

The indications for video-assisted thoracoscopy have steadily expanded during recent years and include now the management of various mediastinal disorders.

METHODS

Until now we have used videothoracoscopy for the diagnosis or treatment of mediastinal mass lesions in 28 patients. The indication for the procedure was bilateral or unilateral mediastinal adenopathy in 16, a suspected malignant anterior mediastinal mass lesion in six, and a presumable benign tumor of the posterior or anterior mediastinum in six patients.

RESULTS

Video-assisted thoracoscopy provided an accurate tissue diagnosis in all patients with adenopathy and in all but one patient with a malignant mass lesion of the anterior mediastinum. It further allowed complete excision of all benign tumors of the anterior or posterior mediastinum. There were no intra- or postoperative complications, but conversion to open thoracotomy was necessary in one patient.

CONCLUSIONS

Video-assisted thoracoscopy is a valuable adjunct to traditional surgical techniques for the diagnosis of malignant mediastinal disease and may overcome some of the limitations of mediastinoscopy and mediastinotomy. In the future, it may become the procedure of choice for the resection of small benign tumors of the anterior or posterior mediastinum.