Evaluate utility, efficacy, and potential advantages of applying videotechnology to mediastinoscopy for the diagnosis of mediastinal disease.
From 01/01/94 through 04/01/04, video-assisted mediastinoscopy (VAM), using a modified Carlens mediastinoscope with a 4-mm, 30-degree-angle viewing telescope connected to a video camera, was done for 460 patients (ages 17-86 yr, mean 62 yr) under general endotracheal anesthesia in a hospital-based ambulatory setting. All patients had imaging studies, prospective screening by an anesthesiologist and predischarge evaluation by the attending surgeon.
Of 374 patients who had mediastinoscopic lung cancer staging, 61 had mediastinal nodal metastasis. Of 74 patients evaluated for undiagnosed mediastinal adenopathy without identifiable lung lesion, 15 had lymphomas, 13 small cell carcinoma, 16 sarcoidosis, 5 granulomas, 2 non-small-cell lung cancer, 2 Castleman disease, 2 metastatic carcinoma of unknown primary site, 1 metastatic renal cell carcinoma, 1 metastatic carcinoma of the esophagus, and the others reactive lymphoid hyperplasia. For obscure mediastinal masses, biopsy confirmed 2 nonseminomatous germ cell tumors, 2 thymic carcinomas, 3 thymomas, 2 cystic lymphangiomas, 1 substernal thyroid, and 2 inflammatory pseudotumors. Complications included 1 major bleeding, 3 transient vocal cord pareses, and 3 superficial wound infections. Benefits included no mortality or hospital readmission.
VAM has the advantage of providing a magnified view with high resolution of mediastinal structures, thus enhancing visualization and safety of dissection and biopsy. Video screen viewing allows the assistant to assume a more active, meaningful role and aids in training residents to perform the procedure.
VAM is effective for evaluating undiagnosed mediastinal adenopathy and obscure mediastinal tumors and for preoperative lung cancer staging. Video assistance enhances visibility; magnifies the operative field; and enables safer, more complete mediastinal evaluation. The procedure can be done with minimal risk in a hospital-based ambulatory setting.
E.C. Saw, None.