BACKGROUND Mediastinoscopy has experienced a renaissance due to the introduction of neoadjuvant treatment protocols and recognition of the limitations of noninvasive mediastinal staging of lung cancer by CT and PET. The aim of this study is to determine the value of video-mediastinoscopy in mediastinal staging of lung cancer. METHODS A total of 60 patients who underwent video-mediastinoscopy for known or suspected lung cancer were retrospectively reviewed. There were 52 cervical mediastinoscopies, 2 parasternal mediastinoscopies and 6 combined procedures. All the patients were found to have enlarged mediastinal lymph nodes on radiographic examination of the chest (more than 1.0cm on its shortest axis). RESULTS Of the 60 patients, 42 patients were found with N2 or N3 disease on video-mediastinoscopy and then were confirmed pathologically. The other 18 mediastinoscopy-negative patients underwent thoracotomy for pulmonary resection and mediastinal lymph node dissection in the same operative session, in which thoracotomy-proven N0 was found in 17 patients, and N2 in 1 patient (false-negative result by video-mediastinoscopy). The sensitivity, specificity, and accuracy of video-mediastinoscopy for mediastinal staging of lung cancer were 97.7%, 100% and 98.3%, respectively. In the entire group of 60 patients, there was 1 complication (1.7%) , and no perioperative death. CONCLUSIONS Video-mediastinoscopy is a highly effective and safe procedure. It can be used routinely in mediastinal staging of lung cancer.