title: Learning mediastinoscopy: the need for education, experience and modern techniques--interdependency of the applied technique and surgeon's training level.
abstract: OBJECTIVE
  Mediastinoscopy represents the gold standard for invasive mediastinal staging. While learning and teaching the surgical technique are challenging due to the limited accessibility of the operation field, both benefited from the implementation of video-assisted techniques. However, it has not been established yet whether video-assisted mediastinoscopy improves the mediastinal staging in itself.
  
  
  METHODS
  Retrospective single-centre cohort analysis of 657 mediastinoscopies performed at a specialized tertiary care thoracic surgery unit from 1994 to 2006. The number of specimens obtained per procedure and per lymph node station (2, 4, 7, 8 for mediastinoscopy and 2-9 for open lymphadenectomy), the number of lymph node stations examined, sensitivity and negative predictive value with a focus on the technique employed (video-assisted vs standard technique) and the surgeon's experience were calculated.
  
  
  RESULTS
  Overall sensitivity was 60%, accuracy was 90% and negative predictive value 88%. With the conventional technique, experience alone improved sensitivity from 49 to 57% and it was predominant at the paratracheal right region (from 62 to 82%). But with the video-assisted technique, experienced surgeons rose sensitivity from 57 to 79% in contrast to inexperienced surgeons who lowered sensitivity from 49 to 33%. We found significant differences concerning (i) the total number of specimens taken, (ii) the amount of lymph node stations examined, (iii) the number of specimens taken per lymph node station and (iv) true positive mediastinoscopies.
  
  
  CONCLUSIONS
  The video-assisted technique can significantly improve the results of mediastinoscopy. A thorough education on the modern video-assisted technique is mandatory for thoracic surgeons until they can fully exhaust its potential.
authors.affiliation: Department of Thoracic Surgery, Schillerhöhe Hospital, Gerlingen, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Walles
authors.forename: Godehard
authors.initials: G
authors.lastname: Friedel
authors.forename: Tobias
authors.initials: T
authors.lastname: Stegherr
authors.forename: Volker
authors.initials: V
authors.lastname: Steger
mesh_terms: D016009:Chi-Square Distribution; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D059032:Learning Curve; D008197:Lymph Node Excision / Q000193:education*; D008297:Male; D008479:Mediastinal Neoplasms / Q000473:pathology*; D008481:Mediastinoscopy / Q000193:education*; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013663:Teaching / Q000379:methods*; D062606:Tertiary Care Centers; D020535:Video-Assisted Surgery / Q000193:education*