What is mediastinoscopy / mediastinotomy?
Mediastinoscopy is the visual examination of the area inside the middle of your chest between the two lungs known as the mediastinum. Mediastinotomy is simply the surgical opening of the mediastinum.
Mediastinoscopy is a minimally invasive procedure during which a small incision is made in the notch just above your breastbone (sternum). Your surgeon will use a special instrument called a mediastinoscope (scope), which is a thin, tube-like instrument with a camera built into the end. Once inserted into the incision in your upper chest, the scope will then link up to a monitor, allowing the surgeon to see inside your mediastinum.
Mediastinoscopy is a short procedure, normally completed within an hour. It is performed under general anaesthesia which means you will be asleep during the procedure. When your surgeon completes the mediastinoscopy, he will remove the scope from your chest, close the incision with a few stitches and cover it with a dressing.
Why do I need to have mediastinoscopy / mediastinotomy?
The mediastinum contains the heart, trachea (windpipe), oesophagus (gullet), thymus and lymph nodes. During this procedure, your surgeon can examine and evaluate abnormalities in your mediastinum and take tissue samples, called biopsies, from areas of concern, for example, from enlarged lymph nodes. Mediastinotomy gives your surgeon direct access to the more complex structures in your chest that are otherwise inaccessible by mediastinoscopy alone.
The tissue samples collected during the procedure will be sent to the laboratory to be looked at under a microscope and analysed for signs of abnormalities such as infection or cancer. This will allow for a definite diagnosis to be made if cancer is detected.
How do I prepare for this procedure?
Prior to your surgery you will be contacted by the pre-assessment team who will advise you on the process in full detail and schedule you to attend our pre-assessment clinic.
What happens after the procedure?
After your procedure, you will wake up in the recovery area where you will be closely monitored before going to the ward. You may have some discomfort near the incision site or experience some hoarseness or throat soreness from the breathing tube. Once on the ward, the nurses will continue to monitor you, and they will inform you when you can start eating and drinking. You may also have a chest X-ray.
You may experience some pain after the procedure, but you will be given medication to help control this. You will need to take them for a short period of time. For some patients, over-the-counter pain relief such as paracetamol will suffice. If you require stronger pain medication, you will be prescribed the appropriate pain relief and discharged with a week’s supply.
What is the recovery after this procedure?
The surgical team will review you on the ward and advise you when you can be discharged home. In most cases, you will be able to go home on the same day. If we require to monitor you overnight, you will be discharged on the following day, therefore we advise you that you prepare an overnight bag for your admission. Please note, you will need somebody to collect you from the hospital, therefore please arrange ahead of time with your family or friends.
You will be informed how to care for the wound and what arrangements will need to be made if you have any stitches. We advise you that you do not drive for at least a week and until your wound is fully healed. Your surgical follow-up will take place a few weeks after your procedure when your surgeon will contact you with the results.
What are the risks?
Any procedure carries a degree of risks associated with the procedure itself, as well as the general anaesthesia. When consenting to mediastinoscopy / mediastinotomy, the following risks must be considered:
- Infection
- Blood clots
- Bleeding
- Pain and discomfort
If the nerves which go to your voice box are affected during the procedure, you may experience some changes in your voice. This will normalise within a few weeks, but some patients may experience a permanent voice change. A rare complication is air leaking from the lung, which if untreated may lead to lung collapse (pneumothorax). Your surgeon will treat that by inserting a drain to reinflate your lung. Another very rare complications are a tear to the oesophagus or severe bleeding. In this unlikely event, a median sternotomy may be required, which means that your surgeon will need to gain direct access to the structures inside your chest.
During your initial consultation as well as during your consent prior to your procedure, your surgeon will explain the risks and benefits of this procedure and will address any concerns you may have. Any risks associated with general anaesthesia you can discuss with your anaesthetist on the morning of your procedure.
For more information and advice about your thoracic procedure, your hospital stay, the thoracic team and our enhanced recovery programme, please see our Thoracic Surgery Patient Booklet and Patient Diary. You can get in touch by calling us on 0203 456 6047 or by emailing us at uclh.