A mediastinoscopy is a procedure used to examine the mediastinum. This is the space behind the breastbone (sternum) in the middle of the chest, between the 2 lungs. This area can be examined with a tool called a mediastinoscope. This is a long, thin, flexible tube that has a light and a tiny camera. It lets a healthcare provider see the organs and structures of the mediastinum. The images can also be sent to a computer screen and recorded. The mediastinum contains the following structures: -Lymph nodes -The heart and its great vessels -The windpipe (trachea) -The tube that leads down to the stomach (esophagus) -The thymus gland, a part of the immune system
A mediastinoscopy can be performed for many reasons, they may include;
-To remove tissue for further examination to then formulate a treatment plan
-To find the cause of infection or inflammation in the chest cavity
-To confirm diagnosis of certain respiratory diseases
-Allows doctors to see what problems are going on inside the mediastinal area -Allows doctors to take biopsies for pathological analysis
-Risks such as bleeding, infection, a hoarse voice, and pneumothorax may occur
Before the operation, a small needle will be placed into a vein (usually on the back of the hand) to give you fluids and medication. Mediastinoscopy is generally done under general anaesthetic, meaning that you will be asleep for the procedure. 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. The surgeon may make two or three small cuts (incisions) in the chest wall above the breastbone (sternum). These holes are known as 'ports' and are usually about an inch long. The mediastinoscope is inserted through one hole. The camera in the mediastinoscope feeds video images to a computer screen, allowing the surgeon to see inside the chest. Your doctor will also insert special surgical instruments through the other ports. He or she will examine the space in your chest between your lungs and heart. Lymph nodes or abnormal tissue samples will be collected and sent to the laboratory for further tests. After the 'scope' is removed from your chest, all these incisions will be closed with a few stitches and covered with a bandage.This entire procedure takes about 60-90 minutes.
Before the procedure, you will undergo a physical examination, health screening, and laboratory tests. If you have a history of being prone to bleeding or excessive bleeding that is hard to stop or if you or a family member have bruises all over the body, please let the doctor know before the procedure. Please let your medical team know about any allergies you have to medication, food, and any other substance/chemical. You will need to fast for 8 hours before the procedure or as recommended by the doctor. You may need to stop certain medication before the procedure. Please let your doctor know about all medications and supplements you are taking so your doctor can advise if any need to be stopped before the mediastinoscopy. On the day of the procedure, please bring all medication and supplements you regularly take to the hospital. The area that will be operated on will be shaved and cleaned on the day of the procedure. You will be asked to sign consent forms before the procedure. Please read all documents before signing them.
After the procedure, you will likely feel a little tired from the anesthesia. Your symptoms will be observed and monitored closely. You can expect to stay in the hospital for 1-2 days. You may have pain or tenderness at the incisions. It is also common to experience some hoarseness or a sore throat from the breathing tube. Pain medications are usually given to relieve discomfort. Nurses will support you in getting up and walking as soon as possible after the procedure to stimulate blood circulation.
The severity of complications will depend on the patient’s health, but the following complications occur in less than 1% of cases and include:
-Bleeding from the incision
-Temporary or permanent hoarseness if there is an injury or loss to the nerves controlling the vocal cords
-Leakage of lymph into the chest cavity
-Damage to organs within the chest cavity, perforation of the esophagus or airway, paralysis of the muscles of the diaphragm
What are the travel recommendations?
You will need to recover at home for 1-2 weeks. If you have any questions, please talk to your doctor or medical team. · Activity. Avoid activities that involve pulling or pushing, lifting heavy objects, and other strenuous activity for at least 1-2 weeks as these can affect the incision. Avoid sexual intercourse until the incision is healed. · Wound Care. When your doctor allows you to bathe, shower daily with soap. Dry the surgical wound well and keep it clean. Don’t apply any creams, lotions, or powders to the incision until it is fully healed and appears like normal skin. Please contact your doctor if the wound is inflamed or swollen, if the pain is worsening, or if the wound is leaking fluid or blood. · Diet. Your diet should be restricted in accordance to existing medical conditions. Eat healthily to promote wound healing. · Medication. If you are prescribed antibiotics, please take them until you finish them. Please take all medication as prescribed by your doctor. · Exercise. Avoid exercising for at least 1 week. · Appointments. Please keep all follow-up appointments so your wound can be monitored and stitches removed. If you experience any abnormal symptoms, such as fever, difficulty breathing, worsening fatigue, etc., please see your doctor before the scheduled appointment.
How long until I can get my test results?
Your doctor can tell you how the surgery went as soon as it is finished. If biopsy samples were taken, these often require several days to be examined.
What do the results mean?
When doctors look at the biopsies, they will study the size and shape of the cells in your tissue. This will determine whether they are normal (benign) or malignant (cancerous). This type of molecular cell study is called cytology. If the problem is an infection, they will culture the tissue to identify the microorganisms present and select the best medications to treat it.
How is a mediastioscopy different to that of a mediastinotomy?
Mediastinoscopy and mediastinotomy are done by surgeons in an operating room using general anesthesia. For mediastinoscopy, an incision is made in the suprasternal notch, and the soft tissue of the neck is bluntly dissected down to the trachea and distally to the carina. A mediastinoscope is inserted into the space allowing access to the paratracheal, tracheobronchial, azygous, and subcarinal nodes and to the superior posterior mediastinum. In a mediastinotomy a surgical entry to the mediastinum is made through an incision in the parasternal 2nd left intercostal space, allowing access to anterior mediastinal and aortopulmonary window lymph nodes, common sites of metastases for left upper lobe lung cancers.