When no disease is seen in either side of the mediastinum or in either pleural space the right thoracoscopic approach is the preference. The procedure is divided into two parts. First, the thoracoscopic procedure is performed using single lung ventilation. The final stage is the laparoscopic approach. If both sides of the chest are thoracoscopically evaluated, usually the right side is performed first, then the left side and then the laparoscopic procedure.
General anesthesia is induced in the usual manner.
The patient is intubated with a double lumen tube and an nasal gastric tube is placed as well to aid in esophageal identification and mobilization. The esophageal identification may be further aided with a passage of an esophagogastroscope. Transillumination of the esophagus makes it much easier in the middle and posterior mediastinal tissues. Also, the legs are slightly bent and well padded. The patient is taped or securely strapped to the table.