Background: The indications for video-assisted thoracescopy have stead
ily expanded during recent years and include now the management of var
ious mediastinal disorders. Methods: Until now we have used videothora
coscopy for the diagnosis or treatment of mediastinal mass lesions in
28 patients. The indication for the procedure was bilateral or unilate
ral mediastinal adenopathy in 16, a suspected malignant anterior media
stinal mass lesion in six, and a presumable benign tumor of the poster
ior or anterior mediastinum in six patients. Results: Video-assisted t
horacoscopy provided an accurate tissue diagnosis in all patients with
adenopathy and in all but one patient with a malignant mass lesion of
the anterior mediastinum. It further allowed complete excision of all
benign tumors of the anterior or posterior mediastinum. There were no
intra- or postoperative complications, but conversion to open thoraco
tomy was necessary in one patient. Conclusions: Video-assisted thoraco
scopy is a valuable adjunct to traditional surgical techniques for the
diagnosis of malignant mediastinal disease and may overcome some of t
he limitations of mediastinoscopy and mediastinotomy. In the future, i
t may become the procedure of choice for the resection of small benign
tumors of the anterior or posterior mediastinum.