Simultaneous double video mediastinoscopy and video mediastinotomy--a step forward.

Mediastinal lymph node biopsy plays a fundamental role in diagnosis, staging and management of lung cancer. We describe a novel method of using the video-mediastinoscope for concurrent cervical mediastinotomy and anterior mediastinoscopy. We have performed five concurrent procedures using this system in the last 14 months. In four cases, we assessed the aorto-pulmonary (A-P) window lymph nodes. In the fifth case, we performed a cervical mediastinoscopy for para-tracheal and sub-carinal lymphadenopathy followed by an anterior videomediastinotomy, video assisted intrapericardial assessment, direct tumour sampling and A-P window lymph nodal biopsies. Due to the excellent visualisation afforded by the Videomediastinoscope, we were able to avoid an open procedure in all cases. We believe that this represents a major benefit of the videomediastinoscope in select cases.