Mediastinoscopy
Mediastinoscopy is an endoscopic procedure designed to examine the mediastinum, the space located between and in front of the lungs. This minimally invasive technique involves making several small incisions, which helps to reduce trauma, postoperative pain, and promote faster recovery compared to traditional mediastinotomy that requires a larger incision. The procedure is commonly utilized for diagnosing and treating various conditions, including lung cancer, lymphoma, sarcoidosis, and mediastinal tumors. Mediastinoscopy is particularly effective as a staging procedure for non-small-cell lung cancer, boasting high sensitivity and specificity.
During the procedure, a flexible instrument called a mediastinoscope is inserted through a small incision at the base of the neck, allowing surgeons to visualize and obtain tissue samples from the mediastinum. Preparation may involve imaging tests and dietary restrictions prior to the procedure, which typically lasts about an hour. While the recovery period is generally short, lasting one to two days in the hospital, patients can often resume normal activities within a few weeks. Although the risks are relatively low, they include potential complications like bleeding, infection, and nerve damage. The results from biopsies taken during mediastinoscopy play a crucial role in determining the appropriate treatment for the patient’s condition.
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Mediastinoscopy
ALSO KNOWN AS: Thoracoscopic mediastinal biopsy, cervical mediastinoscopy, Chamberlain procedure, anterior mediastinotomy
DEFINITION: Mediastinoscopy is an endoscopic procedure used to examine the mediastinum—the space between and in front of the lungs. Mediastinoscopy uses several small, one-inch incisions to access the mediastinum, thereby minimizing trauma, decreasing postoperative pain, and promoting a shorter hospital stay and a quicker recovery. A mediastinotomy allows physicians a better view of a patient's mediastinum but requires a six-to-eight-inch incision, and the healing time is much longer.
Cancers diagnosed or treated: Sarcoidosis, lung cancer, lymphoma, Hodgkin disease, myasthenia gravis, mesothelioma, mediastinal or neurogenic tumors, thymomas, esophageal cancer
Why performed: Mediastinoscopy is often performed to biopsy or remove and evaluate abnormal mediastinal tissue, lymph nodes, inflammation, or infection. As a staging procedure for non-small-cell lung cancer, it has an 80 percent sensitivity and 100 percent specificity.
Mediastinoscopy is also used to remove malignant lymph nodes and mediastinal tumors. Benign and malignant mediastinal tumors that are not removed can interfere with the normal function of the organs in the mediastinum, including the aorta, vena cava, heart, and pericardium.
Patient preparation: Tests may include a chest X-ray, computed (CT) scan, and (MRI). One week before the procedure, patients must stop taking anticoagulants, as directed by the physician. In general, patients must not eat or drink for eight to ten hours before the procedure.
Steps of the procedure: A sedative may be given before the patient receives general anesthesia. A cardiothoracic surgeon or general surgeon inserts a mediastinoscope—a flexible tube-like instrument with a light and camera—under the sternum through a small incision at the base of the neck. The mediastinoscope is manipulated, and images of the abnormal area are displayed on a computer screen to guide the surgeon during the procedure. CT may also be used during the procedure. Other surgical instruments are inserted through two or three small chest incisions, and a tissue sample is removed. The procedure usually takes about one hour.
After the procedure: The hospital recovery is about one to two days, and some patients may be able to go home the day of the procedure. Before going home, the patient receives a follow-up schedule and aftercare instructions. The patient can generally return to normal activities within three to four weeks after discharge.
Risks: The risks of mediastinoscopy include bleeding, infection, allergic reaction to the anesthetic, blood vessel damage, a tear in the esophagus, and laryngeal nerve injury that can cause permanent vocal hoarseness or collapse of a lung (pneumothorax). The overall complication rate is reportedly low, at under 2.5 percent, with major complications under 0.5 percent and mortality under 0.5 percent.
Results: The biopsy tissue is examined for malignancy, inflammation, or infection. The type and extent of the disease will help determine the patient’s treatment.
Bibliography
Cohen, Edmond. Cohen’s Comprehensive Thoracic Anesthesia. Elsevier, 2022.
Ergene, Gokhan, et al. "Superiority of Video-Assisted to Standard Mediastinoscopy in Non-Small-Cell Lung Cancer Staging." Thoracic and Cardiovascular Surgeon, vol. 60, no. 8, 2012, pp. 541-4. doi:10.1055/s-0031-1299577.
McNally, Peter A., and Mary E. Arthur. "Mediastinoscopy." National Library of Medicine, 12 Sept. 2022, www.ncbi.nlm.nih.gov/books/NBK534863. Accessed 20 June 2024.
"Mediastinoscopy." Cleveland Clinic, 8 Feb. 2022, my.clevelandclinic.org/health/diagnostics/23952-mediastinoscopy. Accessed 20 June 2024.
"Mediastinoscopy." Harvard Medical School, Dec. 2019, www.health.harvard.edu/diseases-and-conditions/mediastinoscopy-a-to-z. Accessed 20 June 2024.
"Mediastinoscopy with Biopsy." MedlinePlus, 18 Apr. 2022, medlineplus.gov/ency/article/003864.htm. Accessed 20 June 2024.
Sivrikoz, C. M., et al. "Is Mediastinoscopy Still the Gold Standard to Evaluate Mediastinal Lymph Nodes in Patients with Non-Small-Cell Lung Cancer?" Thoracic and Cardiovascular Surgeon, vol. 60, no. 2, 2012, pp. 116–21. doi:10.1055/s-0030-1271148.