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Mediastinoscopy
Mediastinoscopy is a surgical procedure done to examine the inside of the upper chest between and in front of the lungs, which is known as the mediastinum. Often it is used to help diagnose lung cancer or cancer of the lymph nodes, and a mediastinoscopy can aid doctors in determining the best treatment options (1).
The procedure involves the insertion of a thin scope, known as a mediastinoscope, through an incision in the lower neck or upper chest area. A tissue sample (biopsy) can be collected through the mediastinoscope and examined under a microscope for diagnosis (1, 2).
In many cases, mediastinoscopy has been replaced by less invasive biopsy methods that use computed tomography (CT), echocardiography (ECG), or bronchoscopy to guide the biopsy needle to the targeted tissue. Mediastinoscopy may still be needed when these methods cannot be used or when they do not provide conclusive results (1).
The procedure is done under general anesthesia. A tube is placed in the throat (endotracheal tube) to assist with breathing. An incision is made either just above the breastbone at the base of the neck or on the left side of the chest near the breastbone, between the 4th and 5th ribs. The mediastinoscope is inserted through the opening, after which the doctor can examine the lungs and mediastinum. Lymph nodes or abnormal tissue may be collected for examination. If necessary, a lymph node biopsy can be examined while the patient is still under anesthesia. If the lymph nodes show cancer, surgery may be done immediately (1).
After the scope is removed from the chest, the incision is closed with several stitches and covered with a bandage. A routine mediastinoscopy usually takes about an hour. Some patients may go home the same day, while others may need to stay in the hospital for a day or two (1, 2).
Complications from mediastinoscopy are rare, and include bleeding, infection, a collapsed lung (pneumothorax), a tear in the esophagus, damage to a blood vessel, or nerve injury (1, 2).
- Rhoads, C., M.D., et al. "Mediastinoscopy." From WebMD.com. Available: http://www.webmd.com/a-to-z-guides/Mediastinoscopy-21507 (Accessed August 10, 2007).
- "Mediastinoscopy." From Harvard Medical School's Harvard Health Publications. Available: http://www.health.harvard.edu/diagnostic-tests/mediastinoscopy.htm (Accessed August 11, 2007).