Exploration with biopsy examination of the mediastinum as described by Eric Carlens1 in 1959 has been a valuable addition to thoracic surgery. The technique should be mastered by all surgeons who do thoracic surgery. Mediastinoscopy is a relatively simple and safe procedure. The main value of the procedure is to reduce the number of unnecessary thoracotomies in patients with intrathoracic lesions. Reynders2 in 1964 reported a positive rate of 36.9%. He found that previous to routine use of mediastinoscopy, there was a 40% nonresectable rate of carcinoma of the lung. With negative mediastinoscopy, the resectable rate was increased to 91%.
Mediastinal lymph nodes are almost always involved with granulomas in sarcoidosis. Thus, one can easily make a diagnosis of sarcoidosis through mediastinoscopy according to MacVaugh and Danielson3 in almost 100% of patients with sarcoidosis.
Mediastinoscopy is best done under endotracheal general anesthesia. The patient is placed