(Cervical Mediastinoscopy; Cervical Mediastinal Exploration; CME)
Definition
Definition
The mediastinum is the area in the middle of the chest between the lungs. A mediastinoscopy is a procedure to look at this area inside the chest. A tube with a light (mediastinoscope) is placed into the upper chest through a small opening (mediastinotomy). The light allows the doctor to see the area.
The Lungs (Cut-away View)Copyright © Nucleus Medical Media, Inc.
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Reasons for Procedure
Reasons for Procedure
This is done to examine the lungs and chest. Tissue samples may be taken ( biopsy). These samples are viewed under a microscope to check for diseases like:
- Cancer of the lungs, bronchi, and chest tissue
- Lymphoma—cancer in the lymphatic system, such as Hodgkin’s disease
- Infection
- Inflammation
- Sarcoidosis —a condition that causes swelling (inflammation) in organs like the lungs, liver, lymph nodes, and spleen
Mediastinoscopy is also done to find out if lung cancer has spread.
Possible Complications
Possible Complications
Complications are rare, but no procedure is completely free of risk. If you are planning to have mediastinoscopy, your doctor will review a list of possible complications, which may include:
- Bleeding
- Infection
- Hoarseness
- Chylothorax—leakage of lymphatic fluid into the chest
- Damage to organs in the chest
- Pneumothorax (collapsed lung)
Factors that may increase the risk of complications include:
- Previous mediastinoscopy or chest or neck surgery
- Pregnancy
- Diabetes or other chronic disease
- Smoking
Discuss these risks with your doctor before this procedure.
What to Expect
What to Expect
Prior to Procedure
Your doctor will explain the procedure to you and ask you to sign a consent form. You will be asked to stop eating and drinking for 8-10 hours before the procedure. Your doctor will tell you whether you should:
- Take any medications before the procedure
- Stop taking certain medications before the procedure
The day of the procedure:
- You will be asked to remove any jewelry, glasses, contact lenses, or dentures.
- Be sure to tell your doctor if you have any allergies.
- You will need someone to drive you home after the procedure.
Anesthesia
You will receive a general anesthetic through an IV in your hand or arm. This will block any pain and keep you asleep throughout the procedure. When you are sedated, a breathing tube will be placed in your throat to help you breathe.
Description of the Procedure
You will lie on the operating table on your back. Your skin will be cleaned with an antiseptic solution. A small cut will be made at the base of your neck, just above your breastbone. The muscles of your lower back will be separated. The mediastinoscope will be placed through the opening. The light from the mediastinoscope will help the doctor see the space between your lungs and heart. Tissue samples may be taken from the lymph nodes or other parts of your chest. The mediastinoscope will be removed and the opening will be closed with stitches. The wound will be covered with a dressing.
Immediately After the Procedure
After the procedure, you will be taken to the recovery room. If all is well, your breathing tube will likely be removed. The tissue samples will be sent to the laboratory for testing.
How Long Will It Take?
30 minutes to 2 hours
How Much Will It Hurt?
General anesthesia prevents pain during surgery. You may be given medication to manage pain and tenderness after the procedure.
Average Hospital Stay
This procedure can be done in an outpatient setting or as part of your hospital stay. The usual length of stay is up to 24 hours if there are no unforeseen complications. Some people may need to stay in the hospital for 1-2 days.
Post-procedure Care
At the Hospital
- You will be taken to the recovery room after the procedure until the anesthetic wears off.
- Achest x-ray may be ordered to check for bleeding or air inside your chest space.
At Home
Be sure to follow your doctor’s instructions.
Call Your Doctor
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
- Redness, swelling, pain, or bleeding from the wound
- Chest pain
- Swelling in the neck
- Difficulty swallowing
- Hoarseness that lasts for more than a few days or worsens
- Shortness of breath
- Signs of infection, including fever and chills
- Joint pain, fatigue, stiffness, rash, or other new symptoms
In case of an emergency, call for emergency medical services right away.
RESOURCES:
CANADIAN RESOURCES:
References:
http://www.health.harvard.edu/diagnostic-tests/mediastinoscopy.htm
Updated June 26, 2014. Accessed February 24, 2015.
6/6/2011 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last Updated: 6/20/2013