Mediastinoscopy

(Cervical Mediastinoscopy; Cervical Mediastinal Exploration; CME)

Pronounced: Mee-dee-ah-stine-OS-scoh-pee
by Alexandra Howson, PhD

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.

The Lungs (Cut-away View)

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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    TOP

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    TOP

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

  1. You will lie on the operating table on your back.
  2. Your skin will be cleaned with an antiseptic solution.
  3. The doctor will make a small cut at the base of your neck, just above your breastbone.
  4. The doctor will separate the muscles of the lower neck and place the mediastinoscope through the opening.
  5. The light from the mediastinoscope will help the doctor see the space between your lungs and heart.
  6. The doctor may take tissue samples from the lymph nodes or other parts of your chest.
  7. When she is finished, the doctor will remove the mediastinoscope and close the opening with stitches.
  8. 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 laboratory for testing.

How Long Will It Take?

30 minutes to 2 hours

How Much Will It Hurt?

General anesthesia prevents pain during surgery. Your doctor may give you pain medicine for pain and tenderness after the procedure.

Average Hospital Stay

This procedure can be done in an outpatient setting or as part of your hospital stay. The usual length of stay is up to 24 hours if there are no unforeseen complications. Some people may need to stay in the hospital for 1-2 days.

Post-procedure Care

At the Hospital

  • You will be taken to the recovery room after the procedure until the anesthetic wears off.
  • Your doctor may order a chest x-ray to check for bleeding or air inside your chest space.

At Home

When you return home, do the following to help ensure a smooth recovery:

  • You may feel sleepy for several hours or even 1-2 days following anesthesia. Do not drive during this time.
  • You may have a sore throat from the tube placement.
    • Use throat lozenges.
    • Gargle with warm water.
  • Keep your wound clean and dry.
    • Wash your hands before touching the wound.
    • Use a soft washcloth to gently wipe the wound with soap and water.
    • Change the dressing as instructed by your doctor.
  • Be sure to follow your doctor’s instructions.

Call Your Doctor    TOP

After you leave the hospital, contact your doctor if any of the following occurs:

  • Redness, swelling, pain, or bleeding from the wound
  • Chest pain
  • Swelling in the neck
  • Difficulty swallowing
  • Hoarseness that lasts for more than a few days or worsens
  • Shortness of breath
  • Signs of infection, including fever and chills
  • Joint pain, fatigue, stiffness, rash, or other new symptoms

In case of an emergency, call for medical help right away.

RESOURCES:

American Cancer Society
http://www.cancer.org/
American Lung Association
http://www.lungusa.org
American Thoracic Society
http://www.thoracic.org

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca/
Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

Kellicker PG. Lymph node biopsy. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 11, 2010. Accessed May 10, 2010.
Mason RJ, Broadduss VC, Murray JF, Nadel JA. Murray and Nadel’s Textbook of Respiratory Medicine . 4th ed. 2005: Saunders. Available at: http://www.mdconsult.com . Accessed May 10, 2010.
Mediastinoscopy. Harvard Health Publications website. Available at: http://www.health.... . Accessed December 8, 2010.
Pinto S. Sarcoidosis. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=860 . Published June 29, 2005. Updated November 11, 2008. Accessed May 10, 2010.
6/6/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed June 2012 by Tajender S. Vasu, MD
Last Updated: 06/05/2012