Complications of mediastinoscopy

Abstract

: The most common mediastinoscopy technique is the video-assisted cervical mediastinoscopy (VAMLA) which is the modern version of the original mediastinoscopy described by Carlens in 1959. The extended-VAMLA and the trans-cervical extended mediastinal lymphadenectomy (TEMLA) techniques permit to biopsy a wider number of lymphonodal stations but they do carry out a high operative risk and are not widespread utilised. The most common perioperative complications in relation to a mediastinoscopy described in literature have been divided in 6 categories: (I) bleeding; (II) left laryngeal nerve palsy; (III) infection; (IV) pneumothorax; (V) tracheal perforation; (VI) oesophageal perforation. Of those, the first three categories are generally considered the most common ones. Of each category we describe tips to try to avoid the complication and the most common surgical management of the complication as presented in literature. In two categories as well, we present a patient’s case from our unit experience including related imaging. The mediastinoscopy is nowadays a routine procedure for a Thoracic Unit and commonly is managed as a day case procedure. Despite being considered a minor procedure it does need a specific training and carries out specific risks, which can vary from minor to catastrophic. The use of a video system permits a safe training and a safer and procedure. our service to coagulopathy