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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 554-558, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RJ Landreneau, SR Hazelrigg, MJ Mack, LD Fitzgibbon, RD Dowling, TE Acuff, RJ Keenan and PF Ferson
Cervical mediastinoscopy is useful for the diagnosis of paratracheal lymph
node metastasis from bronchogenic carcinoma. Access to adenopathy in the
aorticopulmonary window, anterior mediastinal, periazygos, and subcarinal
lymph nodes is difficult with this technique. Operative visibility in these
locations through anterior mediastinotomy, the Chamberlain procedure, is
limited. We have used thoracoscopic mediastinal exploration in 40 patients
with computed tomographic scan evidence of enlarged aorticopulmonary window
(n = 30) or enlarged right periazygos or subcarinal lymph nodes (n = 10).
This procedure was used primarily as an adjunct to cervical mediastinoscopy
in the staging of bronchogenic carcinoma. Adjunctive thoracoscopic nodal
sampling was 100% sensitive and 100% specific in diagnosing the mediastinal
adenopathy. It did not significantly delay thoracotomy in cases of benign
adenopathy. Visibility of the ipsilateral pleural space and mediastinum was
excellent. Thoracoscopic exploration with mediastinal nodal sampling is a
valuable diagnostic adjunct for assessment of adenopathy inaccessible to
cervical mediastinoscopy and can overcome many of the limitations of
anterior mediastinotomy.
ARTICLES
Thoracoscopic mediastinal lymph node sampling: useful for mediastinal lymph node stations inaccessible by cervical mediastinoscopy
Section of Thoracic Surgery, University of Pittsburgh, PA 15213.
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