Mediastinoscopy is a minimum invasive investigation representing a reference in mediastinum exploration and having a major role regarding therapeutic strategies in patients with lung cancer or other mediastinal pathology. Research studies show that this surgical intervention, although having in reality low morbidity and mortality (0.6-3.7% morbidity and 0.2% mortality), is potentially dangerous in non properly trained hands. Mediastinoscopy related complications appear as a consequence of the following: (1) incision and access path; (2) surgical maneuvers and are also general complications as in any other surgical approach related to anesthesiology act or postoperative recovery course. The most frequent complications are surgical-related: hemorrhage, recurrent palsy, pneumothorax, tracheal laceration, esophageal lesions, wound dehiscence or anesthesiology-related such as: cardiac arrest and respiratory hypoxia, various arrhythmias, cerebral insufficiency, amaurosis fugax. From all the complications only 0.1-0.5% have clinical significance, the most dreadful remaining massive hemorrhage, which requires a trained team with a very well equipped operating theatre for thoracic, vascular and cardiac surgery. Frequently in cure and prevention of such disastrous events a close cooperation between radiologist, oncologist, surgeon is required (for method limits) and anesthesiologist and from a different perspective with the bronchologist, pneumologist and gastro-enterologist. In trained hands and in teaching hospitals mediastinoscopy remains the golden standard in mediastinal evaluation, a simple procedure, with low morbidity and mortality.