ABSTRACT
Recognition of advanced lung cancer by using a novel cervicomediastinal exploration technique was first described in 1954 by Dwight Harken. Today, mediastinoscopy remains an excellent minimally invasive technique to evaluate the mediastinal lymph nodes as well as anterosuperior mediastinal masses to histologically distinguish benign, malignant, and infectious processes. In the 1980s, the extended cervical mediastinoscopy (ECM) approach was described, where one accesses the station 5 and 6 lymph nodes through the cervical mediastinoscopy incision by advancing the mediastinoscope over the aortic arch, medial to the left common carotid artery. The proficiency and use of mediastinoscopy to clinically stage patients with lung cancer varies among surgeons. Anterior mediastinotomy can be used to biopsy and diagnose anterior mediastinal masses on the right or left hemithorax. Identifying the subcarinal space is useful to accurately recognize the mediastinal anatomy. Hürtgen described another novel technique in 2003: video-assisted mediastinal lymphadenectomy (VAMLA).
