| These techniques are mainly used to diagnose and | | | | scan demonstrates adenopathy, such an evaluation |
| stagebronchogenic carcinoma, but occasionally are | | | | may still berequired to confirm that the nodes are |
| required toconfirm other malignancies (e.g. lymphoma) | | | | involved by tumourand are not enlarged due to |
| or to diagnosethe causes of adenopathy (e.g. | | | | reactive hyperplasia. |
| sarcoidosis or tuberculosis).At mediastinoscopy an | | | | Thoracoscopy |
| incision is made above thesuprasternal notch, the | | | | The development of video-assisted thoracoscopy |
| tissues anterior to the trachea aredissected and the | | | | hasresulted in a great increase in 'keyhole' thoracic |
| mediastinoscope is inserted. Hilar, subcarinaland | | | | surgery. |
| paratracheal nodes can be inspected, biopsiedor | | | | Open lung biopsy |
| removed. The involvement of mediastinal nodes | | | | Open lung biopsy is most commonly undertaken |
| inbronchogenic carcinoma is common (40% of all | | | | fordiffuse interstitial lung disease, atypical tumours |
| cases) anda positive diagnosis is achieved in | | | | and,occasionally, serious pulmonary infections. A limited |
| sarcoidosis in more than80% of cases. | | | | submammarythoracotomy allows biopsy of the |
| Mediastinotomy is occasionally required to | | | | anterior segmentsof all lobes, as well as inspection of |
| evaluateareas of the mediastinum not accessible at | | | | the pleura and mediastinum. Complications |
| mediastinoscopy, particularly the subaortic fossa on the | | | | (approximately 5%) includeinfection and chronic |
| left side,and most commonly the surgeon gains access | | | | pneumothorax, and there is a smallmortality (less than |
| through thesecond left costal cartilage.The | | | | 4%), reflecting for the most part theserious nature of |
| development of CT scanning has reduced the need | | | | the underlying illness in many of thepatients. For |
| for mediastinoscopy and mediastinotomy. In carcinoma | | | | peripheral lesions in the lung, or diffuse |
| ofthe bronchus a CT scan which demonstrates a | | | | lungabnormalities, thoracoscopic minimally invasive |
| normalmediastinum obviates the need for surgical | | | | techniquesallow access not just to the pleura but to |
| evaluationprior to thoracotomy. However, if the CT | | | | the under lying lung. |