Mediastinoscopy

What is a mediastinoscopy?

A mediastinoscopy (MEE-dee-uh-sty-NOS-koh-pee) is a surgical procedure that lets a healthcare provider see inside your mediastinum, which is between your lungs. This area includes your heart, esophagus and trachea (windpipe).

Providers use a mediastinoscope to view the area. This tool is a thin tube that has its own light and camera. Also, it has the ability to take out a tissue sample, lymph node (part of your immune system) or mass.

Mediastinotomy vs. mediastinoscopy

Healthcare providers use both of these procedures to look at your mediastinum and take samples or lymph nodes from it. They also use these procedures to find out if diseases, including cancers, spread in the area.

A mediastinotomy makes an opening, while a mediastinoscopy uses a scope and a smaller incision. Surgeons can reach more areas when they use a mediastinotomy, but the incision is larger and the recovery time is longer.

Why is a mediastinoscopy performed?

You may need a mediastinoscopy if your provider wants a better look at the area between your lungs. They might want to remove or take a sample of your lymph nodes in this area to look for cancer. Also, they can check the stage (severity) of cancer in your lung, thymus gland or esophagus.

Although it’s less common, your provider may do a mediastinoscopy if you have an infection in your lungs. They can diagnose lymphoma, sarcoidosis or mesothelioma as well.

Are there people who shouldn’t have a mediastinoscopy?

Yes. People with certain conditions shouldn’t have a mediastinoscopy. These include people who:

• Have an inoperable tumor.
• Had a mediastinoscopy in the past.
• Had radiation therapy on their chest.

Who performs a mediastinoscopy?

A cardiothoracic surgeon or general surgeon performs a mediastinoscopy in an operating room. The surgeon needs to be able to open your chest (sternotomy) or do a thoracotomy (cut between your ribs) as a backup option if they need to control more bleeding than expected.

How do I prepare for a mediastinoscopy?

Preparing for a mediastinoscopy procedure starts days before your scheduled test. You need to:

• Go to appointments for a chest X-ray, CT scan, pulmonary function test and others your provider requests.
• Stop taking medicines that thin your blood a few days before your procedure.
• Avoid eating or drinking for a few hours before your procedure.

Is a mediastinoscopy an outpatient procedure?

Yes. You should be able to go home the same day as your mediastinoscopy. Before you go home, your provider will want you to be able to:

• Walk.
• Drink liquids.
• Pee.
• Manage your pain.

How is a mediastinoscopy performed?

There are many mediastinoscopy procedure steps. Your provider will:

1. Give you medicine through an IV in your arm to make you sleep and not feel pain.
2. Put a breathing tube in your throat so a machine can breathe for you.
3. Make a small (about 1 inch) incision above your breastbone.
4. Insert a mediastinoscope through the incision.
5. Move the mediastinoscope to where they want to see.
6. Use the tool on the scope to remove or get a sample of abnormal lymph nodes or spots.
7. Take the mediastinoscope out.
8. Close the wound where they put in the mediastinoscope.
9. Wake you up and remove your breathing tube.

How long does a mediastinoscopy take?

A mediastinoscopy takes about an hour. However, sometimes it can take more time if your provider needs to do more exploring or sampling, or if they encounter complications that require a change to a sternotomy or thoracotomy.

What happens during a mediastinoscopy recovery?

After you wake up from the general anesthesia, you’ll still feel sleepy for a few hours. Your relative or friend can drive you home if you’re not having any issues after your mediastinoscopy. You can’t drive yourself home after you’ve had anesthesia.

You can expect to have numbness in your mouth and throat for a few hours. This is a result of the breathing tube that providers use for giving breaths. For your safety, your provider won’t let you drink or eat during this time. You may have a cough, hoarseness or a sore throat the next day, and pain where your provider made an incision.

You may need a chest X-ray to make sure you don’t have any lung issues after your mediastinoscopy.

Is a mediastinoscopy painful?

Yes. You can expect to need to take pain medicine for a few days after your mediastinoscopy.

What are the risks of mediastinoscopy?

Most of the time, people don’t have mediastinoscopy complications. However, some people can have:

• Lung infection (pneumonia).
• Collapsed lung (pneumothorax).
• Bleeding.
• Infected wound.

The mortality rate for a mediastinoscopy is .09%.

What is the most common complication of a mediastinoscopy?

Bleeding is a complication that happens more often than any other.

What type of results do you get and what do the results mean?

Information from your mediastinoscopy procedure will allow your provider to use a cancer staging system to describe your cancer. The stage tells how large a tumor is and whether it spread.

When should I know the results of the mediastinoscopy?

It may take a few days for a lab to analyze your tissue samples (biopsy). Also, if you have cancer, your provider will need time to create a customized treatment plan based on your results.

When should I call my doctor?

Contact your provider if you have any of these after you go home:

• Chest pain.
• Fever.
• Difficulty breathing.

A note from Cleveland Clinic

Knowing what to expect can help you feel more at ease before having a procedure for the first time. Ask your healthcare provider questions about anything you don’t understand about a mediastinoscopy. Be sure to get any scans your provider needs beforehand and follow instructions about preparing for your procedure.