It is very difficult to obtain accurate staging of mediastinal lymph node metastases (N-staging) in patients with lung cancer. We recommend combined thoracoscopy and mediastinoscopy for the assessment of N-staging. The indications and techniques of these combined procedures are described in this paper. Combined thoracoscopy and mediastinoscopy may provide more accurate N-staging of lung cancer than either procedure alone or a non-invasive staging procedure.
