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Mediastinoscopy

Note: the information below is a general guide only. The arrangements, and the way tests are performed, may vary between different hospitals. Always follow the instructions given by your doctor or local hospital.

What is mediastinoscopy?

Mediastinoscopy is a surgical procedure used to look at an area of the body called the mediastinum. The mediastinum is part of the chest and contains the heart, thymus, oesophagus (gullet), trachea (windpipe), and various nerves and lymph nodes.

Mediastinoscopy is a type of ‘keyhole’ surgery where only very small incisions (cuts) are made to the body. It uses a special instrument called a mediastinoscope. This is a thin, tube-like instrument which has a camera built into the end. The ‘scope’ is inserted into a small incision in the upper chest. The camera feeds pictures from the chest on to a screen. This allows your surgeon to look inside the chest. Mediastinoscopy is often used to take biopsies (small samples of tissue) from the lungs. These samples can then be examined in the laboratory.

What is mediastinoscopy used for?

Mediastinoscopy is done to:

  • Detect problems of the lungs and mediastinum, such as sarcoidosis.
  • Diagnose lung cancer or lymphoma (including Hodgkin’s disease).
  • Check lymph nodes in the mediastinum before considering lung removal surgery to treat lung cancer.
  • Help your doctor recommend the best treatment for lung cancer.
  • Diagnose certain types of infection, especially those that can affect the lungs (such as tuberculosis).

How does mediastinoscopy work?

The surgeon may make two or three small incisions in the chest wall above the sternum (breastbone). These holes are known as ‘ports’, and are usually about an inch long. The surgeon then inserts the mediastinoscope through one hole. The camera in the mediastinoscope feeds video images to a computer screen allowing the surgeon to see inside the chest.

Usually he/she will also insert special surgical instruments through the other incisions. These instruments can be used to remove tissue which may have been seen on an X-ray, or lymph nodes. Once the surgery has finished, the instruments are removed and the incisions are closed, usually with stitches.

What happens during mediastinoscopy?

Mediastinoscopy is generally done under general anaesthetic.Before the procedure, a small needle will be placed in a vein to give you fluids and medications. After you are asleep, a tube (an endotracheal tube – also called an ET tube) will be placed in your throat 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 sternum at the base of your neck. The surgeon may make two or three more incisions to insert other instruments at other places in your chest. The mediastinoscope will be inserted through one of these openings. Your doctor will examine the space in your chest between your lungs and heart. Lymph nodes or abnormal tissue will be collected and sent to the laboratory for further tests. After the ‘scope is removed from your chest, all of the incisions will be closed with a few stitches and covered with a bandage.

The entire procedure usually takes about an hour.

What should I do to prepare for mediastinoscopy?

Your doctor should discuss any specific preparation necessary with you before the procedure. Usually there is not much preparation necessary. If you take anticoagulants (‘blood-thinning’ drugs) you may be asked to stop taking these for a few days before mediastinoscopy. You will also be asked not to eat and drink for a certain length of time before the procedure. Your local hospital will give you information on this.

What can I expect after mediastinoscopy?

Some people may go home after the procedure if the general anaesthesia wears off and they are able to swallow fluids without gagging or choking. Other people may need to stay in hospital for 1 or 2 days. If your stitches are not the dissolving type, you will need to return to your doctor to have them removed.

You may have a slightly sore throat – this is normal and usually due to the tube used to help you breathe during the operation. The sites where the incisions were made may be sore for a few days after the procedure.

Are there any side-effects or complications from mediastinoscopy?

Most people who have a mediastinoscopy do not develop any complications. Sometimes the mediastinoscope can temporarily injure a nerve, which may cause hoarseness. This can occasionally be permanent. In rare cases, bleeding complications might require a transfusion or larger chest surgery. Air leaks from the lung can also occur and occasionally require additional treatment. Usually this involves putting in a drainage tube between your ribs for a few days. Rarely, mediastinoscopy may cause a pneumothorax (collapsed lung) or damage to the oesophagus.

You should contact your doctor if you become unwell after a mediastinoscopy. In particular, if you have any of the following problems:

  • Bleeding from your stitches.
  • A fever.
  • Severe chest pain.
  • Swelling in the neck.
  • Shortness of breath.
  • Difficulty swallowing.
  • Hoarseness of your voice that lasts more than a few days or continues to get worse.

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