Exploration of the mediastimum without recourse to thoracotomy offers many advantages to the patient and to his surgeon. Thoracotomy is always painful and in critically ill patients may carry a high mortality. Surgeons have, therefore, looked for simpler ways of diagnosing certain nonsurgical diseases of the chest and of eliminating unnecessary thoracotomy in patients with unresectable and incurable carcinoma of the lung. The superior mediastinum contains many lymph nodes which are of diagnostic and prognostic value. For this reason surgeons have looked to this area and have developed ways to explore it and biopsy nodes and tumors in this area.
The forerunner of mediastinoscopy was the prescalene lymph node biopsy described by Daniels in 1948.1 Although biopsy of the nodes at the junction of the subclavian and internal jugular veins (in essence the most superior mediastinal nodes) was stressed, this was overlooked by many subsequent surgeons who biopsied only