The thoracoscope as diagnostic tool for solid mediastinal masses.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.