Mediastinoscopy

Definition:
Mediastinoscopy is a surgery that allows doctors to view the middle of the chest cavity and to do minor surgery through very small incisions. It allows surgeons or pulmonary doctors to remove lymph nodes from between the lungs and to test them for cancer or infection. It is also useful for examining the outside surface of the large tubes of the airways (such as the trachea) or for evaluating tumors or masses in the middle chest.
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During a mediastinoscopy, a small incision is made in the neck just above the breastbone or on the left side of the chest next to the breastbone. Then a thin scope (mediastinoscope) is inserted through the opening. A tissue sample (biopsy) can be collected through the mediastinoscope and then examined under a microscope for lung problems, such as infection, inflammation, or cancer. See an illustration of mediastinoscopy.

In many cases mediastinoscopy has been replaced by other biopsy methods that use computed tomography (CT), echocardiography, or bronchoscopy to guide a biopsy needle to the abnormal tissue. Mediastinoscopy may still be needed when these methods cannot be used or when they do not provide conclusive results.

It allows surgeons or pulmonary doctors to remove lymph nodes from between the lungs and to test them for cancer or infection. It is also useful for examining the outside surface of the large tubes of the airways (such as the trachea) or for evaluating tumors or masses in the middle chest.

Why It Is Done?
Mediastinoscopy is done to:

* Detect problems of the lungs and mediastinum, such as sarcoidosis.
* Diagnose lung cancer or lymphoma (including Hodgkin’s disease). Mediastinoscopy is often done to check lymph nodes in the mediastinum before considering lung removal surgery to treat lung cancer. Mediastinoscopy can also help your doctor recommend the best treatment (surgery, radiation, chemotherapy) for lung cancer.
* Diagnose certain types of infection, especially those that can affect the lungs (such as tuberculosis).

How To Prepare for the Test?
Discuss  to your doctor about any concerns you have regarding the need for the procedure, its risks, how it will be done, or what the results will indicate. This procedure is done by either a surgeon or a trained pulmonary specialist. You will need to sign a consent form giving your surgeon permission to perform this test.

Be sure to discuss with your doctor what may be done following each possible biopsy result. If a lymph node contains cancer, surgery may be done to remove the cancer while you are still asleep. To help you understand the importance of this procedure, fill out the medical test information form (What is a PDF document?) .

Before you have a mediastinoscopy, tell your doctor if you:

* Are taking any medications.
* Have allergies to any medications, including anesthetics.
* Have any bleeding problems or take blood thinners, such as aspirin or warfarin (Coumadin).
* Are or might be pregnant.

Also, certain conditions may make it more difficult to do a mediastinoscopy. Let your doctor know if you have:-

* Had a mediastinoscopy or open-heart surgery in the past. The scarring from the first procedure may make it difficult to do a second procedure.
* A history of neck problems or a neck injury, especially hyperextension of the neck.
* Any physical problems of your chest, including those that have been present since birth (congenital).
* Recently had radiation therapy to the neck or chest.

You will receive general anesthesia and be asleep during the mediastinoscopy. To prepare for your procedure:

* Do not eat or drink anything for at 8 to 10 hours before the procedure. If you take daily medications, ask your doctor whether you should take them on the day of the procedure.
* Leave your jewelry at home. Any jewelry you wear will need to be removed before the procedure.
* Remove glasses, contact lenses, and dentures or a removable bridge just prior to the procedure. These will be given back to you as soon as you wake up after the procedure.
* Arrange to have someone drive you home after the procedure if you do not need to stay in the hospital.

Your doctor may order certain blood tests, such as a complete blood count or bleeding factors, before your procedure.

Before the surgery (sometimes on the same day), you will meet with an anesthesiologist to go over your medical history (including medicines and allergies) and to discuss the anesthesia.

How It Is Done ?
Mediastinoscopy is done in an operating room.Mediastinoscopy is done by a chest (thoracic) surgeon and surgical assistants.

Before the procedure, an intravenous (IV) line will be placed in a vein to give you fluids and medications. After you are asleep, a tube will be placed in your throat (endotracheal or ET tube) to help you breathe during the procedure. Your neck and chest will be washed with an antiseptic soap and covered with a sterile drape.

This procedure is almost always done with general anesthesia, which puts you to sleep so you are unconscious during the procedure. General anesthesia is administered by an anesthesiologist, who asks you to breathe a mixture of gases through a mask. After the anesthetic takes effect, a tube is put down your throat to help you breathe. One reason you need this tube is that your head is tilted far back during the procedure. The tube keeps your throat safely open even while your neck is bending backwards.

An incision will be made just above your breastbone at the base of your neck or on the left side of your chest near the breastbone between the 4th and 5th ribs.  A tiny camera on a tube, called a mediastinoscope, is then inserted through the opening. Your doctor can see the work he or she is doing by watching a video screen. Your doctor will examine the space in your chest between your lungs and heart. Lymph nodes or abnormal tissue will be collected for examination. After the scope is removed from your chest, the incision will be closed with a few stitches and covered with a bandage.

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The doctor makes one or two other small incisions to allow additional instruments to reach into your chest. These incisions are usually made next to your sternum, between ribs. A wide variety of instruments are useful in mediastinoscopy. These include instruments that can clip away a lymph node and remove it through one of the small chest incisions. Other instruments can be used to stop bleeding blood vessels by using a small electrical current to seal them closed.

At the end of your surgery, the instruments are removed, the lungs are reinflated, and the small incisions are stitched closed. The anesthesia is stopped so that you can wake up within a few minutes of your procedure, although you will remain drowsy for a while afterward.

The entire procedure usually takes about an hour. After the procedure, you will be taken to the recovery room.

Some people may go home after the procedure if the general anesthesia wears off and they are able to swallow fluids without gagging or choking. Other people may need to stay in the hospital for 1 or 2 days. If your stitches are not the dissolving type, you will need to return to your doctor in 10 to 14 days to have them removed. Mediastinoscopy usually leaves only a tiny scar.

How It Feels
Before the procedure you may be given medication that will make you sleepy and relaxed. You will receive general anesthesia during the mediastinoscopy, which will cause you to be asleep. After you wake up, you may feel sleepy for several hours. You may feel tired for 1 to 2 days after the procedure and have some general aches and pains. You may also have a mild sore throat from the tube in your throat during the procedure. Using throat lozenges and gargling with warm salt water may help relieve your sore throat.
Risk Factors:
You will have a small straight scar (less than an inch long) wherever the instruments were inserted. You may have some discomfort for a few days in the areas of the incisions. Sometimes work in the middle chest can temporarily injure a nerve, which can weaken your vocal cord muscles for a while and cause hoarseness. In rare cases, bleeding complications might require a transfusion or larger chest surgery. Air leaks from the lung can also occur and occasionally require additional treatment such as a drainage tube, called a chest tube, that is placed into the chest between your ribs and left there for a few days.

General anesthesia is safe for most patients, but it is estimated to result in major or minor complications in 3%-10% of people having surgery of all types. These complications are mostly heart and lung problems and infections.

Complications from mediastinoscopy are uncommon but may include bleeding, infection, a collapsed lung (pneumothorax), a tear in the esophagus, damage to a blood vessel, or injury to a nerve near the voice box (larynx) which may cause permanent hoarseness.

After the procedure, contact your doctor immediately if you have:

* Bleeding from your stitches.
* A fever.
* Severe chest pain.
* Swelling in the neck.
* Shortness of breath.
* Difficulty swallowing.
* Hoarseness of your voice that lasts more than a few days or continues to get worse.

Must you do anything special after the test is over?
You should notify your doctor if you experience fever, shortness of breath, shoulder pain, or chest pain. You should not drive or drink alcohol for the rest of the day.

Results:

Mediastinoscopy is a surgical procedure to examine the inside of the chest between and in front of the lungs (mediastinum).

Normal:-

Lymph nodes are small, smooth, and appear normal.

No abnormal tissue, growths, or signs of infection are present.

Abnormal:-

Lymph nodes may be enlarged or appear abnormal, which may indicate sarcoidosis, infection, or cancer. Tissue samples are removed and examined under the microscope.

Abnormal growths (such as a tumor) or signs of infection (such as an abscess) may be found in the chest cavity, or mediastinum.

What Affects the Test?
If you have had mediastinoscopy or open-heart surgery, you may not be able to have this procedure. Scarring from the first procedure may make it difficult to do a second procedure.
What To Think About?
If a lymph node biopsy needs to be examined quickly (while you are still asleep), the sample will be taken immediately to the laboratory. There it will be frozen and sliced into very thin sections for examination under a microscope. If the lymph nodes show that you have cancer, surgery may be done right away to remove the cancer while you are still asleep. If a frozen section sample is not needed, a permanent section is made and the results usually are available in 2 to 4 working days.

Respources:
https://www.health.harvard.edu/diagnostic-tests/mediastinoscopy.htm
http://www.webmd.com/a-to-z-guides/mediastinoscopy-21507

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