About Your Mediastinoscopy

This information will help you get ready for your mediastinoscopy procedure at Memorial Sloan Kettering (MSK).

A mediastinoscopy is a procedure in which your healthcare provider looks at the area in the middle of your chest, between your lungs. This is called your mediastinum (see Figure 1). Your mediastinum contains:

• Your heart
• Your trachea (windpipe)
• Your esophagus (food pipe)
• Lymph nodes (small, bean-shaped glands that help fight infection and cancer)

During a mediastinoscopy, your healthcare provider will make a small (about 1 inch) incision (surgical cut) in the front of your lower neck. They’ll place a metal tube with a light and camera called a mediastinoscope through the cut to examine your chest. Your healthcare provider will take biopsies (tissue samples) of any important areas to check for cancer or other conditions.

One of the most common reasons to perform a mediastinoscopy is to see if lung cancer has spread to lymph nodes in your chest. It can also be done to look at lymph nodes that are larger than normal. You and your healthcare providers will use the results of your mediastinoscopy to plan your treatment, if needed.

The procedure usually takes 60 to 75 minutes.

Getting Ready for Your Procedure

Ask about your medications

You may need to stop taking some of your medications before your procedure. We’ve included some common examples below. For instructions about which medications you can take on the morning of your procedure, talk with your healthcare provider. If you have any questions about your medications, ask your healthcare provider.

Follow your healthcare provider’s instructions for taking aspirin

If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your procedure. Aspirin can cause bleeding.

Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to.

For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your procedure. These things can cause bleeding.

If your healthcare provider gives you other instructions, follow those instead.

For more information, read Herbal Remedies and Cancer Treatment.

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

Stop taking NSAIDs, such as ibuprofen (Advil^® and Motrin^®) and naproxen (Aleve^®), 2 days before your procedure. NSAIDs can cause bleeding.

If your healthcare provider gives you other instructions, follow those instead.

For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

If you have pain or discomfort, take acetaminophen (Tylenol^®). Don’t take more acetaminophen than directed on the label or as instructed by your healthcare provider.

Follow your healthcare provider’s instructions for taking anticoagulants (blood thinners)

If you take medication to thin your blood, you’ll need to stop taking it at some point before your procedure depending on the medication. Some examples are:

• apixaban (Eliquis®)
• aspirin
• clopidogrel (Plavix®)
• dabigatran (Pradaxa®)
• enoxaparin (Lovenox®)
• heparin
• rivaroxaban (Xarelto®)
• warfarin (Coumadin®)

Talk with your surgeon and the healthcare provider who prescribed the medication to find out when to stop.

Medications for diabetes

If you take insulin or other medications for diabetes, you may need to change the dose. Talk with your surgeon and the healthcare provider who prescribes your diabetes medications about what you should do the morning of your procedure.

Get a letter from your cardiologist (heart doctor), if needed

If you have an automatic implantable cardioverter-defibrillator (AICD), you need to get a clearance letter from your cardiologist before your procedure.

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. A responsible care partner is someone who can help you get home safely. They should be able to contact your care team if they have any concerns. Make sure to plan this before the day of your procedure.

If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you still need a responsible care partner with you.

The Day Before Your Procedure

Note the time of your procedure

A staff member from the Admitting Office will call you after 2 p.m. the day before your procedure. If your procedure is scheduled for a Monday, they’ll call you on the Friday before. If you do not get a call by 7 p.m., call 212-639-5014.

The staff member will tell you what time to arrive for your procedure. They’ll also remind you where to go.

If you need to cancel your procedure for any reason, please call the healthcare provider who scheduled it for you.

Instructions for eating and drinking before your procedure

• Do not eat anything after midnight the night before your procedure. This includes hard candy and gum.
• Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
• Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.

The Day of Your Procedure

Things to remember

• Take only the medications your healthcare provider told you to take the morning of your procedure. Take them with a few sips of water.
• Don’t put on any lotion, cream, powder, deodorant, makeup, or perfume.
• Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your procedure can cause burns if it touches metal.
• Leave all valuables, such as credit cards and jewelry, at home.
• If you wear contacts, wear your glasses instead.

What to bring with you

• A list of the medications you take at home, including patches and creams.
• Medications for breathing problems (such as inhalers), if you take any.
• Medications for chest pain, if you take any.
• A case for your glasses.
• Your Health Care Proxy form, if you have completed one.

Where to park

MSK’s parking garage is on East 66^th Street between York and 1^st avenues. If you have questions about prices, call 212-639-2338.

To reach the garage, turn onto East 66^th Street from York Avenue. The garage is about a quarter of a block in from York Avenue. It’s on the right (north) side of the street. There’s a tunnel you can walk through that connects the garage to the hospital.

There are other parking garages located on:

• East 69th Street between 1st and 2nd avenues.
• East 67th Street between York and 1st avenues.
• East 65th Street between 1st and 2nd avenues.

Where to go

Your procedure will be done at Memorial Sloan Kettering Cancer Center (MSK). It’s located at 1275 York Avenue between East 67^th and East 68^th Streets. Once you’re there, take the M elevator to the 2^nd floor. Check in at the desk in the Presurgical Center.

Once you’re in the hospital

Once you arrive at the hospital, you’ll be asked to say and spell your name and date of birth many times. This is for your safety. People with the same or a similar name may be having a procedure on the same day.

When it’s time to change for your procedure, you’ll get a hospital gown, robe, and nonskid socks to wear.

You’ll meet with a nurse before your procedure. The nurse will review your medical history with you. Tell them the dose of any medications (including patches and creams) you took after midnight and the time you took them. The nurse will also check your blood pressure, pulse, temperature, and breathing.

You’ll also meet with your healthcare provider or another member of your surgical team before your procedure. They’ll explain the procedure and answer your questions. They’ll also ask you to sign a consent form, if you haven’t already.

When it’s time for your procedure, you’ll either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed.

You’ll get anesthesia (medication to make you sleep) during your procedure. After you’re asleep, a small tube will be placed into your mouth and into your windpipe to help you breathe during your procedure.

During your procedure

During your mediastinoscopy, your surgeon will make a small incision in the middle of your lower neck to gain access to your chest. They’ll use the mediastinoscope to take biopsies of any abnormal growths or enlarged lymph nodes. These biopsy samples will be sent to the lab to be analyzed. Some of the samples may be looked at right away, while others may be looked at later.

At the end of your procedure, your incision will be closed with stitches that dissolve over time. You may also have wound glue or a small piece of tape (Steri-Strips^™) and a small gauze dressing (bandage) over your incision. Your anesthesiologist will remove the breathing tube.

After Your Procedure

What to expect in the hospital

When you wake up after your procedure, you’ll be in the Post Anesthesia Care Unit (PACU).

You’ll be getting oxygen through a thin tube that rests below your nose. A nurse will be monitoring your temperature, pulse, blood pressure, and oxygen levels. They’ll also check the dressing around your incision. You’ll also have a chest x-ray to make sure your lung isn’t collapsed or deflated.

Your caregiver will be able to join you in the PACU, usually about 90 minutes after you arrive there.

Your nurse will bring you something to drink and eat. You’ll stay in the PACU until you’re fully awake and your healthcare provider has looked at your chest x-ray.

Once you’re ready to go home, your nurse will give you discharge instructions and any prescriptions your healthcare provider ordered. They’ll also answer your questions.

If you had any biopsies done during your mediastinoscopy, the final results will be ready 1 to 2 weeks after your procedure. Your healthcare provider will discuss the results of your biopsy during your follow-up appointment, or their office may call you with your results.

What to expect at home

After you’re discharged, call your healthcare provider’s office to schedule a follow-up appointment for 1 to 2 weeks after your procedure. A nurse will call you the day after your procedure to see how you’re feeling.

You may have side effects for about 1 to 3 days after your procedure. These may include:

• Temporary tenderness or discomfort at your incision site. If you have pain, you can take acetaminophen (Tylenol) or the pain medication your healthcare provider prescribed. If you’re allergic to acetaminophen, ask your healthcare provider what other medication you can take.
• Hoarseness or a sore throat from the breathing tube that was used during your procedure. If your throat is sore, eat a soft diet (such as oatmeal, mashed potatoes, and pasta) for a few days after your procedure.

Caring for your incision

• Keep the dressing over your incision for 24 hours. After 24 hours, you can take it off.
• You can shower 24 hours after your procedure. You can let soap and water run over the area. Remember to leave any glue or Steri-Strips in place until they start to peel at the edges. Once they start peeling, you can take them off.
• Avoid tub baths, swimming pools, and hot tubs for 10 days after your procedure.

You can go back to doing your usual activities as soon as you feel ready.

When to Call Your Healthcare Provider

Call your healthcare provider if you:

• Have difficulty breathing that’s new or getting worse
• Lose your voice or it stays hoarse for 3 days or more
• Have bleeding or redness at the incision site
• Have a fever of 101 °F (38.3 °C) or higher