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• W2034662974 abstract "We read with interest the study by Cho and associates [1Cho J.H. Kim J. Kim K. Choi Y.S. Kim H.K. Shim Y.M. A comparative analysis of video-assisted mediastinoscopy and conventional mediastinoscopy.Ann Thorac Surg. 2011; 92: 1007-1011Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar]. The group compared outcomes of video-assisted mediastinoscopic (VAM) lymph node biopsy in patients with non-small cell lung cancer with outcomes of conventional mediastinoscopy (CM). The study found that VAM examined more mediastinal lymph nodes and fewer nodes remained than by conventional mediastinoscopy. The authors also reported that VAM had fewer complications than CM. Having recently completed a systematic review on this topic including Cho and associates' article [1Cho J.H. Kim J. Kim K. Choi Y.S. Kim H.K. Shim Y.M. A comparative analysis of video-assisted mediastinoscopy and conventional mediastinoscopy.Ann Thorac Surg. 2011; 92: 1007-1011Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar] and seven further articles [2Zakkar M. Tan C. Hunt I. Is video mediastinoscopy a safer and more effective procedure than conventional mediastinoscopy?.Interact Cardiovasc Thorac Surg. 2012; 14: 81-84Crossref PubMed Scopus (34) Google Scholar], we found that CM is a safe procedure associated with low mortality (0% to 0.05%), and morbidity (0% to 5.3%) [1Cho J.H. Kim J. Kim K. Choi Y.S. Kim H.K. Shim Y.M. A comparative analysis of video-assisted mediastinoscopy and conventional mediastinoscopy.Ann Thorac Surg. 2011; 92: 1007-1011Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 3Puhakka H.J. Complications of mediastinoscopy.J Laryngol Otol. 1989; 103: 312-315Crossref PubMed Scopus (67) Google Scholar, 4Hammoud Z.T. Anderson R.C. Meyers B.F. et al.The current role of mediastinoscopy in the evaluation of thoracic disease.J Thorac Cardiovasc Surg. 1999; 118: 894-899Abstract Full Text Full Text PDF PubMed Scopus (270) Google Scholar, 5Venissac N. Alifano M. Mouroux J. Video-assisted mediastinoscopy: experience from 240 consecutive cases.Ann Thorac Surg. 2003; 76: 208-212Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar, 6Karfis E.A. Roustanis E. Beis J. Kakadellis J. Video-assisted cervical mediastinoscopy: our seven-year experience.Interact Cardiovasc Thorac Surg. 2008; 7: 1015-1018Crossref PubMed Scopus (19) Google Scholar, 7Anraku M. Miyata R. Compeau C. Shargall Y. Video-assisted mediastinoscopy compared with conventional mediastinoscopy: are we doing better?.Ann Thorac Surg. 2010; 89: 1577-1581Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar, 8Leschber G. Sperling D. Klemm W. Merk J. Does video-mediastinoscopy improve the results of conventional mediastinoscopy?.Eur J Cardiothorac Surg. 2008; 33: 289-293Crossref PubMed Scopus (62) Google Scholar]. CM has high levels of accuracy (83.8% to 97.2%), and negative predictive value (81% to 95.7%) [1Cho J.H. Kim J. Kim K. Choi Y.S. Kim H.K. Shim Y.M. A comparative analysis of video-assisted mediastinoscopy and conventional mediastinoscopy.Ann Thorac Surg. 2011; 92: 1007-1011Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 7Anraku M. Miyata R. Compeau C. Shargall Y. Video-assisted mediastinoscopy compared with conventional mediastinoscopy: are we doing better?.Ann Thorac Surg. 2010; 89: 1577-1581Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar, 8Leschber G. Sperling D. Klemm W. Merk J. Does video-mediastinoscopy improve the results of conventional mediastinoscopy?.Eur J Cardiothorac Surg. 2008; 33: 289-293Crossref PubMed Scopus (62) Google Scholar]. VAM is also a safe procedure with comparable results to that of conventional mediastinoscopy in terms of mortality (0%) and morbidity (0.83% to 2.9%) [1Cho J.H. Kim J. Kim K. Choi Y.S. Kim H.K. Shim Y.M. A comparative analysis of video-assisted mediastinoscopy and conventional mediastinoscopy.Ann Thorac Surg. 2011; 92: 1007-1011Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 7Anraku M. Miyata R. Compeau C. Shargall Y. Video-assisted mediastinoscopy compared with conventional mediastinoscopy: are we doing better?.Ann Thorac Surg. 2010; 89: 1577-1581Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar, 8Leschber G. Sperling D. Klemm W. Merk J. Does video-mediastinoscopy improve the results of conventional mediastinoscopy?.Eur J Cardiothorac Surg. 2008; 33: 289-293Crossref PubMed Scopus (62) Google Scholar]. We also found the main advantage of VAM in terms of the number of mediastinal biopsies taken (VAM, 6 to 8.5; CM, 5 to 7.13) and number of lymph node stations sampled (VAM, 1.9 to 3.6; CM, 2.6 to 2.98) [1Cho J.H. Kim J. Kim K. Choi Y.S. Kim H.K. Shim Y.M. A comparative analysis of video-assisted mediastinoscopy and conventional mediastinoscopy.Ann Thorac Surg. 2011; 92: 1007-1011Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 7Anraku M. Miyata R. Compeau C. Shargall Y. Video-assisted mediastinoscopy compared with conventional mediastinoscopy: are we doing better?.Ann Thorac Surg. 2010; 89: 1577-1581Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar, 8Leschber G. Sperling D. Klemm W. Merk J. Does video-mediastinoscopy improve the results of conventional mediastinoscopy?.Eur J Cardiothorac Surg. 2008; 33: 289-293Crossref PubMed Scopus (62) Google Scholar]. But we also noted that VAM was associated with more aggressive dissection and actually may have led to more complications reported [7Anraku M. Miyata R. Compeau C. Shargall Y. Video-assisted mediastinoscopy compared with conventional mediastinoscopy: are we doing better?.Ann Thorac Surg. 2010; 89: 1577-1581Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar]. Furthermore, several studies commented on training, although none specifically studied this aspect. CM was described as detrimental to training as it is more difficult due to the limited vision for the trainer to monitor the trainee's performance safely. The use of VAM can provide a better and safer training opportunity because both the trainer and trainee can share the magnified image on the monitor [9Martin-Ucar A.E. Chetty G.K. Vaughan R. Waller D.A. A prospective audit evaluating the role of video-assisted cervical mediastinoscopy (VAM) as a training tool.Eur J Cardiothorac Surg. 2004; 26: 393-395Crossref PubMed Scopus (29) Google Scholar]. We conclude that there is a lack of comprehensive randomized studies to compare both procedures and to support any preference toward VAM over CM. Studies available are retrospective comparing heterogeneous groups of non-matched groups of patients. There is currently very little objective evidence of VAM superiority over CM. ReplyThe Annals of Thoracic SurgeryVol. 94Issue 1PreviewWe thank Zakkar and Hunt [1] for their interest regarding our article [2] and we appreciate the opportunity to reply. First, Zakkar and Hunt noted that video-assisted mediastinoscopy (VAM) was associated with more aggressive dissection and actually may lead to more complications. VAM provides more ergonomic handling and simultaneous display of a magnified image. These two points are vital because the dissection often carries a significant risk of injury to major vascular structures or nerve injury. Full-Text PDF" @default.
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• W2034662974 title "Complication Rates in Mediastinoscopy and Training: Video Versus Conventional Mediastinoscopy" @default.
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