Anterior mediastinal masses can develop due to a number of conditions, most of which
require prompt pathologic diagnosis to initiate appropriate treatment.
Diagnosis can be achieved by surgical and non-surgical methods but Video-Assisted Thoracic Surgery
(VATS) through general anesthesia is frequently preferred due to its minimal invasiveness and optimal
diagnostic yield. One limitation of VATS includes the need for general anesthesia and one-lung
ventilation, which can induce life-threatening adverse effects, particularly in patients with bulky masses
In order to reduce general anesthesia-related operative risks, we employed a VATS biopsy approach
performed by just thoracic epidural or local anesthesia in fully awake, spontaneously ventilating patients.
This surgical method allows a wide visual control of mediastinal compartments, an accurate assessment
of the disease extension and achievement of multiple biopsy specimens from different sites of the mass,
eventually resulting in excellent diagnostic yield. In addition, adequate surgical management of
associated intrathoracic conditions including drainage of pleural-pericardial effusions or pleuralpulmonary
biopsy is possible when necessary.
We believe that this novel and globally less invasive surgical option might thus be included within the
framework of the most reliable methods currently available to achieve a rapid diagnosis and adequate
surgical management in patients with undetermined anterior mediastinal masses.
Keywords: Anterior mediastinum, mediastinal tumor, VATS, awake anesthesia, lymphoma.
