(Cervical Mediastinoscopy; Cervical Mediastinal Exploration; CME)
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.
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Reasons for Procedure
This is done to examine the lungs and chest. Tissue samples may be taken ( biopsy). These samples are viewed under a microscope to check for diseases, such as:
- Cancer of the lungs, bronchi, and chest tissue
- Lymphoma—cancer in the lymphatic system, such as Hodgkin disease
- Inflammation, such as sarcoidosis, which causes inflammation in organs like the lungs, liver, lymph nodes, and spleen
Mediastinoscopy is also done to find out if lung cancer has spread.
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:
- Leakage of lymphatic fluid into the chest (chylothorax)
- Damage to organs in the chest
- An abnormal, large pocket of air in the space between the lungs and chest wall (pneumothorax)
Factors that may increase the risk of complications include:
- Previous mediastinoscopy or chest or neck surgery
- Diabetes or other chronic disease
Discuss these risks with your doctor before this procedure.
What to Expect
Prior to Procedure
You will need to stop eating and drinking for 8-10 hours before the procedure. Your doctor will tell you whether you should:
- Take any medications before the procedure
- Stop taking certain medications before the procedure
The day of the procedure:
- You will be asked to remove any jewelry, glasses, contact lenses, or dentures.
- Be sure to tell your doctor if you have any allergies.
- You will need someone to drive you home after the procedure.
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. When 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. A small cut will be made at the base of your neck, just above your breastbone. The muscles of your lower neck will be separated. The mediastinoscope will be placed through the opening. The light from the mediastinoscope will help the doctor see the space between your lungs and heart. Tissue samples may be taken from the lymph nodes or other parts of your chest. The mediastinoscope will be removed and the opening will be closed 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. A chest x-ray may be ordered to check for bleeding or air inside your chest space.
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. You may be given medication to manage 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.
Once at home, follow instructions on how to care for the wound to prevent infection. You may need to reduce your activity level until you feel better.
Call Your Doctor
Contact your doctor if your recovery is not progressing as expected or you develop complications, such as:
- 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
If you think you have an emergency, call for emergency medical services right away.
Mediastinoscopy. Harvard Health Publications website. Available at: http://www.health.harvard.edu/diagnostic-tests/mediastinoscopy.htm. Updated June 26, 2014. Accessed March 6, 2018.
6/6/2011 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T905141/Treatment-for-tobacco-use: Mills E, Eyawo O, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.
Last reviewed March 2018 by EBSCO Medical Review Board Alan Drabkin, MD Last Updated: 6/20/2013