Eastern Cardiothoracic Surgical Society

Therapeutic Mediastinoscopy: Extended Indications Beyond the Staging and Diagnosis of the Mediastinum
Pierre de Delva, University of Mississippi Medical Center, Jackson, MS, USA


OBJECTIVE: To highlight and define the role of mediastinoscopy as a minimally invasive therapeutic procedure for mediastinal disease.

METHODS: Retrospective cohort review of a single institution experience with therapeutic mediastinoscopy.

RESULTS: Between 2012 and 2018, 15 patients underwent therapeutic mediastinoscopy. Indications included mobilization of substernal goiter, drainage of descending mediastinitis, bronchogenic cyst removal and removal of a mediastinal parathyroid adenoma. No conversions to sternotomy or thoracotomy were required. One patient reported hoarseness following removal of a substernal goiter. There was no mortality or disease recurrence.

CONCLUSIONS: Mediastinoscopy is a useful tool for access to the mediastinum. Although mostly used for the purpose of staging, mediastinoscopy in the hands of thoracic surgeons can be used to treat several mediastinal conditions. In the era of increasing use of endobronchial ultrasound for mediastinal staging, thoracic surgeons should maintain a high level of competency and skill with this procedure as it provides minimally invasive access for therapeutic interventions in the mediastinum.