Key Points

• The role of video-assisted thoracoscopic surgery (VATS) in the diagnosis and treatment of mediastinal diseases has evolved dramatically during the past 2 decades.
• Twenty years ago, VATS was used primarily for diagnostic purposes within the mediastinum.
• With new techniques and operative strategies, VATS is now recognized not only as an invaluable diagnostic modality but also as a viable therapeutic alternative to the open approach and, in selected mediastinal entities, the standard of care.

The role of VATS in the diagnosis and treatment of mediastinal diseases has evolved during the past twenty years. When VATS was first introduced, it was used for the assessment of disease processes within the pleura and lungs. With advances in instrumentation, and increasing experience, practitioners found that they were also able to apply these minimally invasive techniques to disease processes within the mediastinum.

Twenty years ago, VATS was used essentially for diagnostic purposes within the mediastinum.[1] However, as expertise developed and instrumentation evolved, surgeons began to perform truly therapeutic procedures within the mediastinum. With these new techniques and operative strategies, VATS is now recognized not only as an invaluable diagnostic modality but also a viable therapeutic alternative to the open approach and, in selected mediastinal entities, the standard of care.