Mediastinoscopy

What is mediastinoscopy?

Mediastinoscopy involves a small operation to look at an area of the body, called the mediastinum. The mediastinum is part of the chest and contains the heart, gullet (oesophagus), windpipe (trachea) and various nerves. It is the area shown in purple in the image below.

Mediastinum

© By Mikael Häggström (Own work), via Wikimedia Commons

The mediastinum also contains lymph nodes and the thymus. Both of these are part of the immune system and help in fighting infection.

Mediastinoscopy is a type of 'keyhole' surgery where only very small cuts (incisions) are made to the body. It uses a special instrument called a mediastinoscope. This is a thin, tube-like instrument which has a camera built into the end. The 'scope' is inserted into a small incision in the upper chest. This is then linked up to a monitor, allowing the surgeon to see pictures of the chest.

While looking at these pictures, the surgeon may see something which they feel needs investigating further. Using the mediastinoscope they can take very small samples from within the chest. These can then be looked at further under a microscope.

The most common reason for mediastinoscopy is as a staging procedure in the diagnosis of non-small cell lung carcinoma. The results obtained from the procedure are very important in tailoring care for the patient.

Other indications for mediastinoscopy include:

• The diagnosis and removal of mediastinal masses and enlarged lymph nodes.

• Lymphoma, both Hodgkins and non-Hodgkins, can be diagnosed via mediastinoscopy along with sarcoidosis which has similar appearances on imaging.

• A mediastinal mass, such as a thymoma, may be removed using mediastinoscopy, depending on its size.

• A sampling of lymph nodes may diagnose infectious processes such as tuberculosis और fungal infections.

• Benign (non-cancerous) mediastinal cysts can be taken out using mediastinoscopy.

• Mediastinoscopy is used in the diagnosis and treatment of mesothelioma.

Before the operation, a small needle will be placed into a vein (usually on the back of the hand) to give you fluids and medication.

Mediastinoscopy is generally done under general anaesthetic, meaning that you will be asleep for the procedure. After you are asleep, a tube (an endotracheal tube - also called an ET tube) will be placed in your throat to help you breathe during the procedure. Your neck and chest will be washed with an antiseptic soap and covered with a sterile drape.

The surgeon may make two or three small cuts (incisions) in the chest wall above the breastbone (sternum). These holes are known as 'ports' and are usually about an inch long. The mediastinoscope is inserted through one hole. The camera in the mediastinoscope feeds video images to a computer screen, allowing the surgeon to see inside the chest.

Your doctor will also insert special surgical instruments through the other ports. He or she will examine the space in your chest between your lungs and heart. Lymph nodes or abnormal tissue samples will be collected and sent to the laboratory for further tests. After the 'scope' is removed from your chest, all these incisions will be closed with a few stitches and covered with a bandage.The entire procedure usually takes about an hour.

Your doctor should discuss any specific preparation necessary with you before the procedure. Usually there is not much preparation necessary.

नोट: if you take 'blood-thinning' medicines such as warfarin or aspirin, your doctor may ask you to stop taking these for a few days before your operation.

You will also be asked not to eat or drink for a certain length of time before the procedure. Your local hospital will give you information on this.

Some people may go home after the procedure if the general anaesthesia wears off and they are able to swallow fluids without gagging or choking. Other people may need to stay in hospital for one or two days. If your stitches are not the dissolving type, you will need to return to your doctor to have them removed.

You may have a slightly sore throat - this is normal and usually due to the tube used to help you breathe during the operation. The sites where the cuts (incisions) were made may be sore for a few days after the procedure.

Most people who have a mediastinoscopy do not develop any complications.

Sometimes the mediastinoscope can temporarily injure a nerve, which may cause hoarseness. This can occasionally be permanent.

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. Usually this involves putting in a drainage tube between your ribs for a few days.

Rarely mediastinoscopy may cause a collapsed lung (pneumothorax) or damage to the gullet (oesophagus).

You should contact your doctor if you become unwell after a mediastinoscopy. In particular, if you have any of the following problems:

• Bleeding from your stitches.

• A high temperature (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 worsen.

Advances in X-ray technology and surgical techniques mean that it may be possible to offer you options which cause less discomfort than mediastinoscopy.