A mediastinoscopy is a surgical procedure performed to examine the mediastinum. The mediastinum is the space behind the sternum (breastbone) in the middle of the chest that separates the two lungs. It contains lymph nodes, the heart and its great vessels, the trachea, the esophagus, and the thymus gland.
The mediastinum can be visualized by the use of an endoscopic instrument called a mediastinoscope. A mediastinoscope is a lighted, long, thin, flexible tube that can visualize the organs and structures of the mediastinum. It also has the capacity to transmit images onto a TV-like monitor.
The procedure is performed in an operating room under general anesthesia. The surgeon makes a small incision in the neck above the top of the sternum and inserts the mediastinoscope. In addition to directly visualizing the mediastinum, tissue samples of mediastinal lymph nodes may be obtained. These lymph nodes receive lymphatic drainage from the lungs. A biopsy of these lymph nodes helps to identify disease processes that may be present in the mediastinum and the lungs.
The primary reason for mediastinoscopy is to visualize, examine, and biopsy lymph nodes for identification of disease processes in the mediastinum, particularly the staging of lung cancer. Determining the “stage” or the extent to which cancer has spread is important in planning the proper treatment. While positron emission tomography (PET scan) is becoming more useful in staging cancer, mediastinoscopy remains an important diagnostic tool when tissue biopsy is required.
Other related procedures that may be used to diagnose problems of the lungs and respiratory tract are chest X-ray, chest fluoroscopy, bronchoscopy, bronchography, chest ultrasound, lung scan, pleural biopsy, oximetry, pulmonary angiogram, pulmonary function tests, sinus X-ray, thoracentesis, computed tomography (CT scan) of the chest, and PET scan. Please see these procedures for additional information.
The respiratory system is made up of the organs involved in the exchange of gases, and consists of the:
The upper respiratory tract includes the:
The lower respiratory tract includes the lungs, bronchi, and alveoli.
The lungs take in oxygen, which cells need to live and carry out their normal functions. The lungs also get rid of carbon dioxide, a waste product of the body's cells.
The lungs are a pair of cone-shaped organs made up of spongy, pinkish-gray tissue. They take up most of the space in the chest, or the thorax (the part of the body between the base of the neck and diaphragm).
The lungs are enveloped in a membrane called the pleura.
The lungs are separated from each other by the mediastinum, an area that contains the following:
The right lung has three sections called lobes. The left lung has two lobes. When you breathe, the air enters the body through the nose or the mouth. It then travels down the throat through the larynx (voice box) and trachea (windpipe) and goes into the lungs through tubes called mainstem bronchi.
One mainstem bronchus leads to the right lung and one to the left lung. In the lungs, the mainstem bronchi divide into smaller bronchi and then into even smaller tubes called bronchioles. Bronchioles end in tiny air sacs called alveoli.
A mediastinoscopy is primarily performed to visualize, examine, and biopsy lymph nodes to aid in determining the stage of lung cancer and potential surgical options. Conditions of the mediastinum that may be detected by mediastinoscopy may include, but are not limited to, the following:
By determining the stage of lung or mediastinal cancer, if present, the doctor can plan for additional surgical procedures or other types of treatment.
There may be other reasons for your doctor to recommend a mediastinoscopy.
As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:
Mediastinoscopy may be contraindicated in certain situations, including, but not limited to, the following:
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
A mediastinoscopy may be performed on an outpatient basis or as part of your stay in a hospital. The procedure will be performed while you are asleep under general anesthesia. Procedures may vary depending on your condition and your doctor’s practices.
Generally, a mediastinoscopy follows this process:
After surgery, you will be taken to the recovery room for observation. Your recovery process will vary depending on the type of anesthesia that is given, as well as the type of procedure that was performed. If a more extensive procedure was performed, your recovery process will take longer, and you will most likely be admitted to the hospital for a day or so.
The area of your incision will be monitored for bleeding. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.
Your doctor may order a chest X-ray after the procedure to check for bleeding or air in the pleural space.
Once you are home, it is important to keep the incision area clean and dry. Your doctor will give you specific bathing instructions. If stitches are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry, and generally will fall off within a few days.
You may resume your normal diet unless your doctor advises you differently.
Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medication.
Your doctor may recommend using throat lozenges for a sore throat.
Notify your doctor to report any of the following:
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.
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