MEDIASTINOSCOPY, THORACOSCOPY, AND VIDEO-ASSISTED THORACIC-SURGERY INTHE DIAGNOSIS AND STAGING OF LUNG-CANCER

The surgical approach to the diagnosis and staging of lung cancer requ ires the assessment of the lung parenchyma, hilum, pleura, chest wall, and intrathoracic lymph nodes. Chest computerized tomography is sensi tive in defining the location of the primary tumor, but is relatively insensitive to invasion. Similarly, radiographic imaging can identify lymph node enlargement, but lymph node enlargement alone is insufficie nt for accurate staging. To facilitate the tissue biopsies of both the primary tumor and potential sites of metastatic disease, video thorac oscopy has provided a useful complement to traditional bronchoscopy an d mediastinoscopy. These instruments provide minimally invasive access to the lung, pleura, and ipsilateral lymph nodes. The combined applic ation of thoracoscopy, bronchoscopy, and mediastinoscopy can provide i ntrathoracic staging information while minimizing surgical morbidity.