Minimally-invasive complete resection of intrathoracic mediastinal lesions with a Linder-Dahan spreadable-blade video mediastinoscope system: A report of two cases

• Schwannoma/parathyroid cyst was resected using Linder-Dahan video mediastinoscope.
• Resection with video, spreadable blades, and a scope-holding device was excellent.
• Linder-Dahan video mediastinoscopy improves safety, preciseness, and operability.
• Linder-Dahan video mediastinoscopy has similar invasiveness as standard procedures.
• Procedural simulation with 3-D PET/CT virtual mediastinoscopy is useful.

IntroductionCervical mediastinoscopy can provide a minimally invasive access to the paratracheobronchial mediastinum within its reachable range, but its operability is substantially limited because of its small operative field, poor visualisation, and one-handed operation.Presentation of casesPatient 1, a 56-year-old woman, presented with a 22 × 17 mm, non-symptomatic, 18F-fluorodeoxy glucose (FDG)-avid, solid schwannoma originating from the vagus nerve trunk in the right upper paratracheal space. Patient 2, a 55-year-old man, presented with a 55 × 41 mm cystic mass in the left upper paratracheal space that extensively compressed and dislocated the trachea toward the right, which caused dyspnoea and cervicothoracic pain. The masses in both cases were completely resected using a Linder-Dahan spreadable-blade video mediastinoscope.DiscussionThe addition of the video system and spreadable blades to the conventional scope combined with a scope-holding device has enabled effective bi-manual preparation and more precise and safer mediastinoscopic procedures than those performed using the conventional one-handed mediastinoscope. Owing to the improved operability, more complex or extended procedures could be performed in wider and more stable operative spaces with better visualisation, although the system has the same minimal invasiveness as that of the conventional mediastinoscope.ConclusionWe describe two patients with mediastinal lesions that were effectively resected by using this sophisticated video mediastinoscope system.