Mediastinoscopy (definition of)

Mediastinoscopy is a diagnostic procedure during which the inside of the thorax, known as the mediastinum, is examined. It is generally used to help diagnose lung or lymphatic cancer and aids the oncology team in determining appropriate treatment options. Mediastinoscopy can be used for diagnosing diseases such as mesothelioma.

During this procedure, a thin scope known as a mediastinoscope is inserted through an incision in the lower neck or upper chest. A tissue sample, or biopsy is collected through this instrument and analyzed in a pathology lab.

In recent years, mediastinoscopy has been replaced by the use of computed tomography (CT), echocardiography (ECG) and bronchoscopy, all of which are less invasive methods of guiding the biopsy needle to the targeted tissue. Mediastinoscopy may still be needed however if and when such methods are inappropriate for a patient's condition or do not provide conclusive results (1).

Mediastinoscopy is performed under general anesthesia. An endotracheal tube is placed in the patient's throat to assist with breathing, and an incision is made either just above the breastbone at the base of the neck or on the left side of the chest between the 4th and 5th ribs. The mediastinoscope is then inserted through this opening. If the lymph nodes show signs of cancer, surgery may be done right then and there.

Once the scope is removed, the incision is closed with stitches and covered with a sterile dressing. A routine mediastinoscopy takes about sixty minutes. Complications from mediastinoscopy are unusual, but may include bleeding, infection, lung collapse (pneumothorax), esophageal tearing, blood vessel damage and nerve injury.