Mediastinoscopy is a surgical procedure to examine the inside of the upper chest between and in front of the lungs (mediastinum).
During a mediastinoscopy, a small cut (incision) is made in the neck just above the breastbone or on the left side of the chest next to the breastbone. Then a thin scope (mediastinoscope) is inserted through the opening. A tissue sample (biopsy) can be collected through the mediastinoscope and then examined under a microscope for lung problems, such as infection, inflammation, or cancer. See a picture of mediastinoscopy.
In many cases mediastinoscopy has been replaced by other biopsy methods that use computed tomography (CT), echocardiography, or bronchoscopy to guide a biopsy needle to the abnormal tissue. Mediastinoscopy may still be needed when these methods cannot be used or when they do not provide conclusive results.
Why It Is Done
Mediastinoscopy is done to:
How To Prepare
You will be asked to sign a consent form before mediastinoscopy. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. Be sure to discuss with your doctor what may be done following each possible biopsy result. If a lymph node contains cancer, surgery may be done to remove the cancer while you are still asleep. To help you understand the importance of this procedure, fill out the medical test information form(What is a PDF document?).
Before you have a mediastinoscopy, tell your doctor if you:
Also, certain conditions may make it more difficult to do a mediastinoscopy. Let your doctor know if you have:
You will receive general anesthesia and be asleep during the mediastinoscopy. To prepare for your procedure:
Your doctor may order certain blood tests, such as a complete blood count or clotting factors, before your procedure.
How It Is Done
Mediastinoscopy is done by a chest (thoracic) surgeon and surgical assistants.
Before the procedure, an intravenous (IV) line will be placed in a vein to give you fluids and medicines. After you are asleep, a tube will be placed in your throat (endotracheal or ET tube) to help you breathe during the procedure. Your neck and chest will be washed with an antiseptic soap and covered with a sterile drape.
An incision will be made just above your breastbone at the base of your neck or on the left side of your chest near the breastbone between the 4th and 5th ribs. The mediastinoscope will be inserted through the opening. Your doctor will examine the space in your chest between your lungs and heart. Lymph nodes or abnormal tissue will be collected for examination. After the scope is removed from your chest, the incision will be closed with a few stitches and covered with a bandage.
The entire procedure usually takes about an hour. After the procedure, you will be taken to the recovery room.
Some people may go home after the procedure if the general anesthesia wears off and they are able to swallow fluids without gagging or choking. Other people may need to stay in the hospital for 1 or 2 days. If your stitches are not the dissolving type, you will need to return to your doctor in 10 to 14 days to have them removed. Mediastinoscopy usually leaves only a tiny scar.
How It Feels
Before the procedure, you may be given medicine that will make you sleepy and relaxed. You will receive general anesthesia during the mediastinoscopy, which will cause you to be asleep. After you wake up, you may feel sleepy for several hours. You may feel tired for 1 to 2 days after the procedure and have some general aches and pains. You may also have a mild sore throat from the tube in your throat during the procedure. Using throat lozenges and gargling with warm salt water may help relieve your sore throat.
Complications from mediastinoscopy are uncommon but may include bleeding, infection, a collapsed lung (pneumothorax), a tear in the esophagus, damage to a blood vessel, or injury to a nerve near the voice box (larynx) which may cause permanent hoarseness.
After the procedure, contact your doctor immediately if you have:
Mediastinoscopy is a surgical procedure to examine the inside of the chest between and in front of the lungs (mediastinum).
What Affects the Test
If you have had mediastinoscopy or open-heart surgery, you may not be able to have this procedure. Scarring from the first procedure may make it difficult to do a second procedure.
What To Think About
If a lymph node biopsy needs to be examined quickly (while you are still asleep), the sample will be taken immediately to the laboratory. There it will be frozen and sliced into very thin sections for examination under a microscope. If the lymph nodes show that you have cancer, surgery may be done right away to remove the cancer while you are still asleep. If a frozen section sample is not needed, a permanent section is made and the results usually are available in 2 to 4 working days.
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