This information explains your mediastinoscopy surgery.

Purpose

The gray area is the mediastinum.The heavy black line is where the incision will be made. The gray area is the mediastinum.The heavy black line is where the incision will be made. A mediastinoscopy is an operation done with general anesthesia. It lets your doctor see and biopsy lymph nodes and masses in the area between your lungs. This area is called the mediastinum. (See illustration.)

The most common reason it is done is to see if lung cancer has spread to the nodes in that area. It can also be done to diagnose other diseases. Some of these are not cancer. The information obtained from the operation is often important in helping your doctor choose the proper treatment plan for you.

Time

This operation is often done along with a bronchoscopy. The total time in the operating room is about 60 to 75 minutes.

Preparation

Tell your doctor or nurse if you are taking any other medicines, including:

  • Medicines that do not require a prescription
  • Herbal remedies
  • Vitamins
  • Dietary supplements

Some of these may interact with medicines you will be given during surgery.

Ask your doctor which medicines you should take on the day of your procedure. Take them with a small sip of water. Your nurse will give you a card that tells you the names of common drugs that have aspirin, anti-inflammatory medicines, or vitamin E. The card explains when you must stop taking these and tells you what you can take instead. If you use inhalers or drugs for your heart or high blood pressure, please bring them with you to the hospital. You may not eat or drink anything after midnight the night before your procedure.

Because you will have general anesthesia, you must have a care partner take you home after the procedure. This person must be an adult. When you arrive at the hospital, we will ask you to give us the name and phone number of the person who will escort you home. If we cannot confirm your care partner, your procedure will be canceled.

Day of The Procedure

A nurse will review your medical history. He or she will then check your blood pressure, pulse, temperature, and respiration. The staff will be happy to answer any questions that you or your family members may have. After this, you will be taken to the dressing room to change. You will be given a hospital gown, slippers, robe, and denture cup (if you wear dentures). Shortly after changing, you will go the operating room. Your care partner will be told how long the operation is expected to last and where to meet you afterwards.

Procedure

After you are asleep, a small breathing tube will be placed into your mouth, past your throat. The bronchoscopy will be done first.

For the mediastinoscopy, a small incision will be made just above your sternum (breast bone). A small hollow tube with a light is inserted through the incision. The structures behind your sternum and between your lungs will be inspected. Tissue (lymph node or mass) samples will be collected. After the exam the tube is removed. The small incision is closed with sutures (surgical stitches). The tissue samples are sent to the lab for analysis. A small dressing (gauze) may be placed over the incision site.

After The Procedure

You will be brought to the first recovery room, which we call the PACU. You will remain there for about 2 hours. Your vital signs will be checked every 15 to 30 minutes. A chest x-ray will be done to check for any postoperative complications. This is to make sure your lung is not collapsed or deflated. Although complications are possible, they rarely occur.

You will move to the second recovery room when:

  • You are fully awake
  • Your vital signs are stable
  • Your doctor has looked at your chest x-ray

This is called the PACU II. It has chairs for you and your visitors to sit in.

While you are in the second recovery area, your vital signs will be checked again. You will meet your care partner here and have something to eat and drink. A nurse will give you discharge instructions and any prescriptions your doctor ordered. The nurse will also answer any questions you may have. Ask when the results of any biopsies will be ready.

After you are discharged, you should call your doctor's office for a follow-up appointment. A nurse will call you the day after the operation to see how you are feeling.

Home Care

You may have:

  • Temporary tenderness or discomfort at the incision site
  • Hoarseness, or a sore throat because of the breathing tube used in the procedure

You may take acetaminophen (Tylenol®), if you are not allergic to it, or pain medicine prescribed by your doctor. If you are allergic to acetaminophen, ask your doctor what other medicine you may take. Eat a soft diet for a few days if your throat is sore.

You may resume your normal activities as soon as you feel able. You may remove the dressing and shower the day after the operation. Under the dressing, you may have steri strips over the incision. These thin strips of tape help to hold the incision in place. Take your first shower with them on and rub the area gently with soap and water. Remove them like a bandage after your first shower. If you do not have steri strips, just clean the incision gently with regular soap and water.

Call Your Doctor or Nurse If You Develop

  • Difficulty breathing or shortness of breath
  • A rapid heart beat
  • Bleeding or redness at the incision site
  • A temperature of 101° F (38.3° C) or greater