ABSTRACT
The application of thoracoscopic techniques in the treatment of various lung diseases has
already been discussed. The same advances which have allowed surgeons to approach the
most complex lung pathology using minimal access surgery (MAS) techniques has also
expanded the indications in other intrathoracic lesions involving the mediastinum and
esophagus. Standard approaches to the mediastinum and esophagus have included medias-
tinoscopy, anterior thoracotomy, sternotomy, and posterolateral thoracotomy. Each tech-
nique has its advantages and limitations but all can be associated with significant
morbidity and recovery. The least invasive approach to the anterior mediastinum, medias-
tinoscopy, is severely limited by the degree of access and control it allows the surgeon, and
the visual field is extremely confined. This procedure allows the surgeon to perform only
limited evaluations and biopsies of the paratracheal space and is a difficult technique to
master. Anterior thoracotomy provides greater access but the visual field is still signifi-
cantly limited. The greatest advantage of these approaches is that they allow the
surgeon to stay extrapleural. However, if bleeding or other problems are encountered
the surgeon has little choice but to hope the bleeding tamponades or to perform a sternot-
omy. Posterolateral thoracotomy and sternotomy greatly improve the surgeons’ access and
visualization but both have significant morbidity and recovery.
