Mediastinoscopy and mediastinotomy

A mediastinoscopy is a procedure that lets the doctor examine the space in the chest between the lungs. This space is called the mediastinum. It is done using a mediastinoscope, which is a type of endoscope. The mediastinoscope is placed through a small cut made at the base of the neck just above the breastbone.

If the area that needs to be looked at can’t be reached through the cut in the base of the neck, you may have a mediastinotomy. It is done through a small cut between the upper ribs on the left side of the body.

A mediastinoscopy or mediastinotomy is done to:

• diagnose lung diseases or tumours
• see if cancer has spread to lymph nodes in the mediastinum
• take samples of the lymph nodes or abnormal growths in the mediastinum
• help stage lung cancer and determine if lung tumours can be operated on or not
• identify certain infections or inflammation

Mediastinoscopy and mediastinotomy are done in a hospital operating room on an outpatient basis, so you can usually go home the same day. You may be sleepy after the test is done, so someone will need to drive you home.

Your healthcare team will give you instructions on how to prepare for the test. You may be told to not eat or drink anything for 6 to 12 hours before the test. Tell your healthcare team about all prescription and non-prescription medicines you are taking.

Mediastinoscopy and mediastinotomy are done with general anesthetic, which means you will be asleep during the procedure.

Depending on what procedure is being done, the surgeon will make a small cut (incision) at the base of the neck (for a mediastinoscopy) or between an upper rib (mediastinotomy). The mediastinoscope is inserted into the mediastinum through the incision.

When the exam is done, the mediastinoscope is removed. The incision is closed with stitches and covered with a bandage.

A mediastinoscopy or mediastinotomy usually takes between 60 and 90 minutes. You may be a little tender or sore where the cut was made. You may also have a sore throat.

Complications can happen with any procedure. They are rare after a mediastinoscopy or mediastinotomy but may include:

• bleeding
• infection
• hoarseness – caused by injury to a nerve near the voice box (larynx)
• collapsed lung
• a tear (puncture) in the trachea or esophagus

An abnormal result may mean that:

• there is mesothelioma or lung cancer
• the cancer has spread to the lymph nodes in the centre of the chest
• the cancer has spread too far for surgery to be a treatment option

The doctor will decide whether you need further tests, procedures, follow-up care or more treatment.

Being prepared for a test or procedure can reduce anxiety, increase cooperation and help the child develop coping skills. Parents and caregivers can help prepare children by explaining to them what will happen, including what they will see, feel, hear, taste or smell during the test.

Preparing a child for a mediastinoscopy or mediastinotomy depends on the age and experience of the child. Find out more about helping your child cope with tests and treatments.