Mediastinoscopy
(Cervical Mediastinoscopy; Cervical Mediastinal Exploration; CME)
Pronounced: Mee-dee-ah-stine-OS-scoh-pee
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Definition
The mediastinum is the area in the middle of the chest between the lungs. A mediastinoscopy is a procedure to look at this area inside the chest. A tube with a light (mediastinoscope) is placed into the upper chest through a small opening (mediastinotomy). The light allows the doctor to see the area.
Reasons for Procedure
This is done to examine the lungs and chest. The doctor might take tissue samples ( biopsy ). These samples are viewed under a microscope to check for diseases like:
- Cancer of the lungs , bronchi, and chest tissue
- Lymphoma—cancer in the lymphatic system (eg, Hodgkin’s disease )
- Infection
- Inflammation
- Sarcoidosis —a condition that causes swelling (inflammation) in organs like the lungs, liver, lymph nodes, and spleen
Mediastinoscopy is also done to find out if lung cancer has spread.
Possible Complications
Complications are rare, but no procedure is completely free of risk. If you are planning to have mediastinoscopy, your doctor will review a list of possible complications, which may include:
- Bleeding
- Infection
- Hoarseness
- Chylothorax—leakage of lymphatic fluid into the chest
- Damage to organs in the chest
- Pneumothorax (collapsed lung)
Factors that may increase the risk of complications include:
- Previous mediastinoscopy or chest or neck surgery
- Pregnancy
- Diabetes or other chronic disease
- Smoking
Discuss these risks with your doctor before this procedure.
What to Expect
Prior to Procedure
Your doctor will explain the procedure to you and ask you to sign a consent form. You will be asked to stop eating and drinking for 8-10 hours before the procedure. Your doctor will tell you whether you should:
- Take any medicines before the procedure
- Stop medicines like insulin , aspirin , or blood-thinning medicines
The day of the procedure:
- You will be asked to remove any jewelry, glasses, contact lenses, or dentures.
- You may be given medicines to help you feel sleepy and relaxed.
- Be sure to tell your doctor if you have any allergies.
- You will need someone to drive you home after the procedure.
Anesthesia
You will receive a general anesthetic through an IV in your hand or arm. This will block any pain and keep you asleep throughout the procedure. Once you are sedated, a breathing tube will be placed in your throat to help you breathe.
Description of the Procedure
- You will lie on the operating table on your back.
- Your skin will be cleaned with an antiseptic solution.
- The doctor will make a small cut at the base of your neck, just above your breastbone.
- The doctor will separate the muscles of the lower neck and place the mediastinoscope through the opening.
- The light from the mediastinoscope will help the doctor see the space between your lungs and heart.
- The doctor may take tissue samples from the lymph nodes or other parts of your chest.
- When she is finished, the doctor will remove the mediastinoscope and close the opening with stitches.
- The wound will be covered with a dressing.
Immediately After the Procedure
After the procedure, you will be taken to the recovery room. If all is well, your breathing tube will likely be removed. The tissue samples will be sent to the labora