Video-Assisted Thoracoscopic Access to the Mediastinum

Summary

Video-assisted Thoracic Surgery (VATS) is now routinely employed as a reliable diagnostic method for undetermined mediastinal masses and lymphadenopathy. It can also prove useful for lung and esophageal cancer staging due to the possibility of a comprehensive assessment of the pleural cavity, lung and mediastinum. Therapeutic VATS has been successfully applied to thymectomy, excision of small encapsulated anterior mediastinal tumours and posterior neurogenic tumours, management of benign esophageal conditions, pericardiectomy and pericardioscopy. Furthermore, VATS has also been employed in combination with laparotomy and cervicotomy to perform esophagectomy for esophageal cancer.

Despite a wide spectrum of potential applications, the surgeon’s judgement must play a key role in deciding which procedure is best suited for adopting VATS. In fact, despite a shortened hospital stay and an easier patient acceptance of the procedure, VATS equipment is expensive, time in the operating room may be long and inadvertent intraoperative complications can be lifethreatening and difficult to manage promptly. For this reason, we believe that use of VATS in the management of mediastinal diseases should be never performed without adequate training, while, the advantages of using it for more complex therapeutic procedures will always require a careful comparison with those deriving from already validated open approaches.