Current Thoracic Surgery

Background: The diagnostic reach of mediastinoscopy depends on adequate tissue sampling. However, adequate tissue sampling may not be possible with conventional blunt dissection methods, especially in the presence of thick encapsulated mediastinal lymph nodes or a mass. It reduces the diagnostic success of mediastinoscopy, and patients may therefore easily result in misdiagnosis. Here, we present a new sharp dissection technique, which we use in cases where adequate tissue sampling from the mediastinal lymph nodes is essential and blunt dissection does not provide it.

Materials and Methods: Between 2016-2022, we performed mediastinoscopy in 298 patients and analysed retrospectively. Biopsy could not be taken from mediastinal lymph node and/or mediastinal mass by conventional methods in 26 patients (8.7%). While biopsy could be taken with surgical instruments developed for other operations in 14 of these patients, the needle dissection technique was performed in the remaining 12 patients who cannot be taken a biopsy with conventional and/or surgical instruments developed for other operations.

Results: In patients who needed this technique in mediastinoscopy, all of the tissue with diagnostic value was sampled, no complications were observed, and the most common diagnosis was tuberculosis (n = 8, 66.6%).

Conclusions: The use of surgical instruments developed for other operations such as long and thin aspirator and forceps, endoscopic scissors, injection needle and endoclips in addition to standard surgical instruments in mediastinoscopy and also performing this needle dissection technique may increase the diagnostic success of mediastinoscopy.