What is the test?
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 or for evaluating tumors or masses in the middle chest.
How do I prepare for the test?
Discuss the specific procedures planned during your mediastinoscopy ahead of time with your doctor. 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.
If you are taking insulin, discuss this with your doctor before the test. If you take aspirin, nonsteroidal anti-inflammatory drugs, vitamin E, or other medicines that affect blood clotting, talk with your doctor. It may be necessary to stop or adjust the dose of these medicines before your test. It is likely that you will be able to go home the same day as the surgery, but you will need to arrange for someone else to drive you home. This is because you will have received medicines that can leave you drowsy for some hours after the procedure.
You will be told not to eat anything for at least eight hours before the surgery. An empty stomach helps prevent the nausea that can be a side effect of anesthesia medicines.
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.
What happens when the test is performed?
Mediastinoscopy is done in an operating room. You wear a hospital gown and have an IV (intravenous) line placed in your arm so that you can receive medicines through it.
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.
A very small incision (less than an inch long) is made above your breastbone (sternum). Carbon dioxide gas is allowed to flow into your chest through this opening, while your lungs are made to slightly deflate, giving your doctors a space within which to work. The tube, called a mediastinoscope, is then inserted through the opening. At the far end of the tube is a light and small camera, that projects a picture onto a television screen. Your doctor can see the work he or she is doing by watching the screen.
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.
What risks are there from the test?
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.
Must I 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.
How long is it before the result of the test is known?
Your doctor can tell you how the surgery went as soon as it is finished. If biopsy samples were taken, these often require several days to be examined.