Mediastinoscopy is a surgical procedure used to examine the mediastinum, a space in the middle of the chest, between the lungs, also called the breastbone. Many vital structures, including the heart, vessels, trachea, esophagus, thymus glands, and essential nerves are a part of this area. Besides it also functions to protect the pathway for structures, traversing from the neck straight into the abdomen. The process provides access to the lymph nodes in the aortopulmonary window. 

To perform mediastinoscopy, a long, flexible tube called a mediastinoscope that has a torch, and a tiny camera lets the doctor see, screen, and record all the organs in a detailed manner. A tiny incision around 2 to 3 cm is made, the instrument is inserted, and a thoracic surgical procedure is performed to examine the mediastinum. In most cases, the lymph nodes are thoroughly examined specifically to find out the progression of lung cancer. Sometimes, if required, the nodes are removed. The test also lets the person determine the best and most timely treatment options for lung cancer.

Also Read: Lung Cancer: Causes, Symptoms, And Treatment
Mediastnoscopy

Besides looking for lung cancer progression, mediastinoscopy is used to find other health problems such as:

  • Cancer of the bronchi
  • Hodgkin disease
  • Sarcoidosis
  • Cancer of other structures in the mediastinum
  • Acute infection or inflammation
  • Cancer that starts in the lymphatic system
  • Non-Hodgkin's Lymphoma
  • Thymoma or a tumor of the thymus gland 

How Is Mediastinoscopy Performed?

This surgical procedure is done in the hospital as an outpatient procedure, and an overnight stay in a hospital is not required. Before going ahead with the procedure, the health care provider should know about all the medicines, vitamins, and supplements that are being taken, and he or she should be aware of all allergies to medicines. 

The doctor may also ask not to eat or drink anything for at least several hours before the procedure. General anesthesia is given, and the procedure takes about one to one and a half hours to complete. Before administering GA, an endotracheal tube is placed in the patient's nose or mouth to help them breathe. 

By making a small surgical above the breastbone near the sternum, a mediastinoscope is inserted through this cut and passed into the mid-part of the chest smoothly. Any abnormal lymph nodes are removed and to be biopsied later. The surgical cut is closed with stitches, and the procedure many concluded by taking a chest X-ray. If biopsies are done as part of the procedure, the results typically will be ready within a few days.

What Are The Risks Of Mediastinoscopy?

All procedures come with certain risks depending on the general health of the patient. Certain factors such as a previous mediastinoscopy, heart surgery, or cervical spine surgery could be one of these, besides pregnancy and blockage in the large vein (also called superior vena cava obstruction.) If the patient has had an automatic implantable cardioverter-defibrillator (AICD), a clearance letter from the cardiologist before your procedure is a must. 

The risks of this procedure may also include the following:

  • Severe bleeding
  • Infection in the lung or pneumonia  
  • Paralysis of the laryngeal nerve
  • Air in the space between the lungs
  • Subcutaneous emphysema or when air gets trapped under the skin 
  • Infection due to the incision
  • Phrenic nerve injury

When To Call The Doctor?

After the procedure, the patient's mouth and throat will probably be numb for a few hours, and he or she will not be allowed to eat or drink until the numbness wears off. Once the numbness is gone, there could be a sore throat, cough, or hoarseness for the next day or so. These are considered normal after mediastinoscopy. However, if there are sudden problems such as severe chest pain, breathing problems, coughing up blood, or a fever that doesn't go away in a few weeks, one should get in touch with your physician at the earliest.

Conclusion

Mediastinoscopy is a procedure in which the healthcare provider looks at the area in the middle of the chest located between the lungs called the mediastinum. It allows direct inspection and or biopsy of lymph nodes and other masses located in the anterior mediastinum. Besides checking for other anomalies, one of the most common reasons to perform a mediastinoscopy is to check if lung cancer has spread to lymph nodes in the chest. Despite a safe procedure, morbidity related to mediastinoscopy ranges from 2 to ten percent, the most severe complication of this surgical procedure being hemorrhage. Other potential complications include airway obstruction, compression of the innominate artery, pneumothorax, infections due to incision, phrenic nerve injury, and esophageal injuries.