Mediastinoscopy

Mediastinoscopy

Mediastinoscopy is a surgical procedure to perform a biopsy of the lymph nodes in the middle of the chest or to biopsy a mass around the trachea. The procedure is performed to help with the diagnosis of an enlarged lymph node or as part of staging for lung cancer.

Operation

The operation is performed through a small incision above the breastbone. The muscle overlying the airway is separated and a mediastinoscope is inserted above the airway. The lymph nodes or the mass around the airway are identified, removed and sent to the pathologist for analysis.

Overall the risk of the operation is very low. Rare complications may occur and include bleeding, pneumothorax and wound infection. There are very rare complications of injury to the major vessels such as the pulmonary artery, aorta and azygus vein as well as injury to the trachea or bronchus. When these very rare complications occur, a median sternotomy may be required to fix the injury. Another very rare complication is an injury to the recurrent laryngeal nerve, which controls your vocal cords. The injury to the recurrent laryngeal nerve may result in hoarseness and the need for further procedures to correct the problem.

Recovery at home

After the operation, the patient goes to a recovery area called PACU or post-anesthesia care unit. Once the patient recovers from anesthesia, the patient is discharged home. The incision has a clear waterproof dressing that usually falls off in 2 weeks. After 2 weeks, the clear dressing can be removed. Patients can take a shower the next day but cannot take baths or go swimming for 6 weeks.

Pain Management

We also advise our patients to stay ahead of the pain with pre-emptive pain control. Instead of taking pain medication after having pain, we ask patients to take pain medication in regular intervals. The typical regimen for post-operative pain medication is:

3 days of Aleve (Naprosyn) 1 tab two times a day

5 days of Tylenol (Acetaminophen) 1 g three times a day

After 5 days, take Tylenol as needed. If this regimen is not adequate to control pain, we ask patients to call our office.