The role of mediastinoscopy for diagnosis of isolated mediastinal lymphadenopathies

Mediastinoscopy is a diagnostic and/or therapeutic procedure through which it is realized visualization of the mediastinum contents, most times ending with a biopsy. Such procedure is often used in lung cancer for staging of the lymph nodes, or for a diagnosing purpose in several affections related to mediastinum (lymphoma or sarcoidosis). Morbidity is fairly low (0.2-0.5%), being encountered left recurrent laryngeal nerve injury, bleeding and pneumothorax. Contraindications are represented by previous mediastinoscopy, oncologic treatments (chemotherapy/ radiotherapy, due to development of mediastinal adhesions and fibrosis), or severe limitations in hyperextension of the neck (cervical arthritis, cutaneous tracheostomy). This paper presents the most important advantages and utility of mediastinoscopy, which proved during a long period of time to be safe, accurate and cost effective thoracic surgery technique. It minimizes the period of hospitalization and allows appropriate treatment to be immediately commenced upon diagnosis. Although there are a number of known complications of mediastinoscopy, it remains the ultimate diagnostic investigation for paratracheal and retrovascular enlarged mediastinal lymphnodes in centers where endo-bronchial ultrasound is absent or video assisted thoracoscopic surgery is not possible