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We thank Zakkar and Hunt [1Zakkar M. Hunt I. Complication rates in mediastinoscopy and training: video versus conventional mediastinoscopy (letter).Ann Thorac Surg. 2012; 94: 342Abstract Full Text Full Text PDF Scopus (5) Google Scholar] for their interest regarding our article [2Cho J.H. Kim J. Kim K. Choi Y.S. Kim H.K. Shim Y.M. A comparative analysis of video-assisted mediastinoscopy and conventional mediastinoscopy.Ann Thorac Surg. 2011; 92: 1007-1011Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar] and we appreciate the opportunity to reply. First, Zakkar and Hunt noted that video-assisted mediastinoscopy (VAM) was associated with more aggressive dissection and actually may lead to more complications. VAM provides more ergonomic handling and simultaneous display of a magnified image. These two points are vital because the dissection often carries a significant risk of injury to major vascular structures or nerve injury. To our knowledge, Anraku and colleagues [3Anraku M. Miyata R. Compeau C. Shargall Y. Video-assisted mediastinoscopy compared with conventional mediastinoscopy: are we doing better?.Ann Thorac Surg. 2010; 89: 1577-1581Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar] are the only authors to report that VAM resulted in more complications than conventional mediastinoscopy (CM). It is difficult to fathom that, given the better visualization that VAM affords the surgeon, a more thorough and liberal dissection during VAM might lead to a higher complication rate. We think that it is more reasonable to conclude that this technique yields a clearer view of the mediastinal structure and thus a lower complication rate. The patient sample studied by Anraku and colleagues [3Anraku M. Miyata R. Compeau C. Shargall Y. Video-assisted mediastinoscopy compared with conventional mediastinoscopy: are we doing better?.Ann Thorac Surg. 2010; 89: 1577-1581Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar] comprised a 4:1 ratio of CM patients (N = 396) to VAM patients (N = 104), and they included diagnostic group of patients (N = 145) when they compared complications. Furthermore, they did not show clearly whether the complications in each group occurred in patients for whom the procedures were performed for diagnostic or staging purposes. Our results included complications only for patients in whom the primary goal was staging for lung cancer. It is difficult to compare results according to the method of mediastinoscopy in terms of training. However, VAM is certainly a much easier and more standardized method for teaching mediastinoscopy. We agree that a preference for VAM over CM cannot be shown with certainty in the absence of comprehensive randomized studies comparing the two techniques. Complication Rates in Mediastinoscopy and Training: Video Versus Conventional MediastinoscopyThe Annals of Thoracic SurgeryVol. 94Issue 1PreviewWe read with interest the study by Cho and associates [1]. The group compared outcomes of video-assisted mediastinoscopic (VAM) lymph node biopsy in patients with non-small cell lung cancer with outcomes of conventional mediastinoscopy (CM). The study found that VAM examined more mediastinal lymph nodes and fewer nodes remained than by conventional mediastinoscopy. The authors also reported that VAM had fewer complications than CM. Full-Text PDF