The application of combined video-mediastinoscopy and video-thoracoscopy in the staging of lung cancer has remained infrequent, despite preliminary demonstration of its technical feasibility. Cytopathological diagnoses should be carried out as well as possible in order to achieve the accurate diagnosis. Especially in a group of patients, 1- with lesions in both the mediasinum and a hemi thorax, 2 - with lung cancer which has high provability of up staging if using this combined technique before surgery and 3 - who underwent induction therapy. For this purpose, this technique is one of the most unfailing methods. This article reviews the rationales and the techniques of this method.