Complications after performing mediastinoscopy are uncommon, but they may occur even for an experienced surgeon. The major complications have the potential to be life-threatening injuries, such as major vascular or airway injury. A 51-year-old man presented to our hospital due to mediastinal node enlargement on follow-up after he had undergone gastric cancer surgery 2 years previously. An iatrogenic bronchial rupture occurred while performing mediastinoscopic biopsy, and this injury was primarily repaired with multiple direct interrupted sutures, along with the aid of a homemade knot pusher under video mediastinoscopy, and we did not have to convert to an open thoracotomy.