Mediastinoscopy

Mediastinoscopy is a surgical procedure that examines the mediastinum, the middle section of the chest containing the structures separating the two sides of your chest. It is commonly used to help diagnose conditions like lung cancer and infections in the chest. 

If you or a loved one are scheduled for a mediastinoscopy, read on to understand more about the procedure and what to expect before, during and after the test.

What is a mediastinoscopy?

A mediastinoscopy is a procedure used to check the mediastinum (the middle part of your chest, between your lungs). It contains your heart, large blood vessels, food pipe (esophagus), windpipe (trachea), lymph nodes and nerves. These parts work together to help you breathe, pump blood and digest food.

A mediastinoscopy is usually performed by thoracic surgeons or specially trained general surgeons who are experts in surgeries involving the chest area. The surgeon uses a mediastinoscope, a thin tube fitted with a light and tiny camera. The tube is passed through a small cut (incision) just above the breastbone and slowly moved into the mediastinum to view the area. It can also take out a tissue sample (biopsy), lymph node or growth.

How is a mediastinoscopy different from a mediastinotomy?

A mediastinotomy (or mediastinal exploration) is a more serious procedure than a mediastinoscopy. While a mediastinoscopy uses a scope, a mediastinotomy involves a large cut (incision) in the chest wall to access the mediastinum directly. This allows surgeons to reach more areas and might be done if the problem is more serious.

Why might I need a mediastinoscopy?

Your health care provider may recommend a mediastinoscopy if you have signs or test results showing something unusual in your chest, such as swollen (enlarged) lymph nodes, masses or suspected lung cancer. It is often done to remove or biopsy lymph nodes in the area to diagnose and stage conditions like cancer, lymphoma, thymoma (rare tumor) and infections.

Possible complications of a mediastinoscopy

A mediastinoscopy is considered a safe procedure. But like other surgical procedures, it has some risks, including: 

• Bleeding
• Infection in the lung (pneumonia)
• Reaction to the medication (sedation and general anesthesia) that helps you relax and sleep
• Hoarseness or problems swallowing
• Collapse of part of the lung (pneumothorax)
• Need for a sternotomy, opening the breast bone, to access the mediastinum

If you have any worries or questions about getting a mediastinoscopy, it's important to talk to your provider. They’ll help you understand everything and ensure your safety during the procedure.

How to prepare for a mediastinoscopy

Your provider will give you specific instructions on how to prepare, but here are a few steps to ensure everything goes smoothly:

• Sign a consent form: You may be asked to sign a form giving your provider permission to perform the procedure. Read the form carefully and ask your provider if anything is unclear.
• Adjust medications: Your provider may ask you to adjust or temporarily stop your medications and/or dosage, especially blood thinners, to reduce the risk of bleeding during the procedure. If you have ongoing conditions such as diabetes or heart disease, your provider will give you specific instructions about your medications.
• Fasting: You will need to stop eating or drinking before the procedure, typically starting the night before. Fasting helps ensure your stomach is empty, reducing the risk of problems like vomiting.
• Testing: Your provider may order tests, such as blood tests, chest X-rays or CT scans, to assess your overall health and the condition of your chest.
• Make arrangements: Since you will be under sedation or general anesthesia for the procedure, you will not be able to drive yourself home afterward. Arrange for a responsible adult to bring you home from the hospital or surgical center. You may need to take time off work or arrange help for childcare, household chores and other tasks during recovery.

Let your provider know if you have allergies or reactions to medications, latex or tape and if you are pregnant or think you may be pregnant.

What to expect during a mediastinoscopy

A mediastinoscopy is usually an outpatient procedure (meaning you don’t need to stay in the hospital afterward). However, how a mediastinoscopy is performed may vary depending on your condition and your provider’s practices. 

In general, it follows this process:

• You will change into a gown and remove any jewelry or other objects. This ensures that you are comfortable during the procedure and allows your provider easy access to the area being looked at.
• You will lie on a bed or table and various monitors will be attached to monitor your vital signs, such as heart rate, blood pressure and oxygen levels. An intravenous (IV) line will be placed in your arm to give you medicine.
• You will be given general anesthesia through the IV or via a mask to ensure you are unconscious (asleep) and pain-free throughout the procedure.
• Once sedated, the surgeon will make a small incision, usually less than an inch long, in the lower part of your neck just above the breastbone. 
• The surgeon will carefully insert and move the mediastinoscope through the incision into the mediastinum. The camera on the end of the scope allows the surgeon to see the area and biopsy or remove abnormal lymph nodes or other tissues. If more surgery is needed, it may be done at this time.
• After the surgeon is done, the scope will be removed and the incision will be closed with stitches or surgical glue.

The procedure may take 30 minutes to 1 hour, depending on why your provider is performing the procedure.

Recovery from a mediastinoscopy

After the procedure, you’ll be taken to a recovery area where you’ll rest until the medicine's effects wear off. You may feel a little groggy or sleepy for a short time. Your health care team will monitor your vital signs and may perform a chest X-ray to check for bleeding or air in the lungs.

You will need to have someone bring you home after the procedure. Some centers will not discharge you to go home in a cab or ridesharing service. Talk with your health care team about the policy for the use of these services or about other resources available for getting home.

You may experience mild side effects after the procedure, such as a sore throat, coughing or a hoarse voice. These symptoms are usually temporary and should improve within a day or two. Warm water gargles and throat lozenges may help.

Your provider will provide you with specific post-procedure instructions. These may include information on when you can start eating and drinking, how to care for the incision site, any medications you need to take and any activities you should avoid. 

Call your provider immediately if you have any of the following:

• Fever and chills
• Coughing up blood
• Severe hoarseness or changes in voice
• Feel dizzy or faint
• Increased pain or redness around the incision

Call 911 or have someone take you to the nearest emergency department if you experience any of the following:

• Sudden chest pain
• Difficulty breathing and swallowing or gasping for air 
• Sudden loss of consciousness

How do I understand my results?

After your mediastinoscopy, your health care provider will review what they found during the exam. If they took a tissue sample, the results may take some time to get.

Depending on the results, your provider may schedule a follow-up appointment to discuss the findings, treatment plans or further tests as needed. If you have questions about your results, ask your provider to help you understand.

Expert care 

At Banner Health, we provide compassionate, expert care to support your overall health and well-being. If you have questions about mediastinoscopy, contact us today. Your journey to better lung health begins with Banner Health.