This information will help you prepare for your mediastinoscopy procedure at Memorial Sloan Kettering Cancer Center (MSK).
Mediastinoscopy is a procedure in which your doctor looks at the area in the middle of your chest, which is called the mediastinum. It is located between your lungs (see Figure 1) and contains your heart, trachea (windpipe), esophagus (food pipe), and lymph nodes (small, bean-shaped glands that help fight infection and cancer).
During a mediastinoscopy, your surgeon will make a small incision (surgical cut) in the middle of your lower neck. He or she will place a lighted metal tube with a camera called a mediastinoscope through the cut to examine your chest. Your surgeon will take biopsies (tissue samples) of any important areas to check for cancer or other conditions.
A mediastinoscopy is usually done to see if lung cancer has spread to lymph nodes in the chest or to examine lymph nodes that are abnormally large to rule out other cancers and conditions. You and your doctors will use the results of your mediastinoscopy to help choose the right treatment plan for you.
The procedure typically takes 60 to 75 minutes.
10 Days Before Your Procedure
You may need to stop taking some of your medications before your procedure. We have included some common examples below. If you have any questions about your medications, ask your doctor or nurse.
- Stop taking vitamin E and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®) 7 days before your procedure because they can increase your risk of bleeding. If you’re having pain or discomfort, take acetaminophen (Tylenol®) instead. Do not take more acetaminophen than directed on the label or as instructed by your doctor. Ask your nurse for the resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs) or go to: www.mskcc.org/cancer-care/patient-education/resources/common-medications-containing-aspirin-and-other-nonsteroidal-anti-inflammatory-drugs-nsa
- Stop taking any herbal remedies and supplements 7 days before your procedure, because they may increase your risk of bleeding. Ask your nurse for the resource Herbal Remedies and Cancer Treatment, or go to: www.mskcc.org/cancer-care/patient-education/resources/herbal-remedies-and-treatment
- If you take medication to thin your blood, you will need to stop taking it at some point before your procedure depending on the medication. Some examples are warfarin (Coumadin®), dalteparin (Fragmin®), heparin, tinzaparin (Innohep®), enoxaparin (Lovenox®), clopidogrel (Plavix®), and cilostazol (Pletal®). Speak with your surgeon and the doctor who prescribed the medication to determine when to stop.
- If you take insulin or other medications for diabetes, you may need to change the dose. Speak with your surgeon and the doctor who prescribes your diabetes medications what you should do the morning of your procedure.
For instructions about what medications you can take on the morning of your procedure, speak with your surgeon.
If you have an automatic implantable cardioverter-defibrillator (AICD), you will need to get a clearance letter from your cardiologist before your procedure.
You must have someone 18 years or older take you home after your procedure. Please call one of the agencies below if you do not have someone who can do this. They will help find someone to take you home.
- Partners in Care: 888-735-8913
- Caring People: 877-227-4649
- Prime Care: 212-944-0244
The Day Before Your Procedure
A clerk from the Admitting Office will you after 2:00 pm on the day before your procedure. He or she will tell you what time you should arrive at the hospital for your procedure. If your procedure is scheduled on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call 212-639-5014.
If you need to cancel your procedure for any reason, please call the doctor who scheduled it for you.
- 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
- Take only the medications your doctor told you to take the morning of your procedure. Take them with a few sips of water.
- Do not put on any lotion, cream, powder, deodorant, makeup, or perfume.
- Remove all jewelry, including body piercings.
- Leave all valuables, such as credit cards and jewelry, at home.
- If you wear contacts, wear your glasses instead.
- A list of the medications you take at home, including patches and creams
- Medications for breathing problems (such as inhalers), medications for chest pain, or both
- A case for your glasses
- Your Health Care Proxy form, if you have completed one
Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that you can walk through that goes from the garage into the hospital. If you have questions about prices, call 212-639-2338.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Please arrive at the Surgical Day Hospital (SDH) at 1275 York Avenue between East 67th and East 68th Streets. This is the main building of MSK. Take the M elevator to the 2nd floor.
Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to state and spell your name and date of birth many times. This is for your safety. Patients with the same or similar name may be having procedures on the same day.
Your nurse will review your medical history. He or she will check your blood pressure, pulse, temperature, and breathing. Your doctor will explain the procedure to you and answer any questions you may have. He or she will ask you to sign a consent form.
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.Back to top
During Your Procedure
You will get anesthesia (medication to make you sleepy). After you are asleep, a small tube will be placed into your mouth and into your windpipe to help you breathe during your procedure.
During your mediastinoscopy, your surgeon will make a small incision in the middle of your lower neck to gain access to the chest. He or she will use the mediastinoscope to take biopsies of any masses or enlarged lymph nodes. These biopsy samples will be sent to the lab to be analyzed; some of the samples may be looked at immediately.
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-StripsTM) and a small gauze dressing over your incision. Your anesthesia doctor will remove the breathing tube.Back to top
After Your Procedure
You will be taken to the Post Anesthesia Care Unit (PACU), where your nurse will monitor your temperature, heart rate, breathing, and blood pressure. He or she will also check the dressing around your incision.
You will have a chest x-ray to make sure your lung is not collapsed or deflated. You will stay in the PACU until you are fully awake and your doctor has looked at your chest x-ray. Your caregiver will be able to join you and you can have something to eat and drink. Your nurse will give you discharge instructions and any prescriptions your doctor ordered. He or she will also answer any questions that you may have. If you had any biopsies, you can expect to get the final results after a week or longer.
After you are discharged, you should call your doctor’s office to schedule a follow-up appointment. A nurse will call you the day after your procedure to see how you are feeling.
Some of the side effects include:
- Temporary tenderness or discomfort at the incision site.
- Hoarseness or a sore throat from the breathing tube that was used during your procedure.
If you have pain, you can take acetaminophen (Tylenol®) or the pain medication prescribed by your doctor. If you are allergic to acetaminophen, ask your doctor what other medication you can take. If your throat is sore, eat a soft diet for a few days after your procedure.
If you have a dressing over your incision, you can remove it and take a shower on the day after your procedure. If you have Steri-Strips™ or glue, you may shower with them on, applying soap and water gently to the area. When the edges of the tape or glue begins to peel, you may remove them.
Avoid tub baths, swimming pools, and hot tubs for 10 days after your procedure.
You can resume your normal activities as soon as you feel ready.
- Have difficulty breathing that is getting worse
- Lose your voice or it stays hoarse 3 days or more
- Have bleeding or redness at the incision site
- Have a temperature of 101° F (38.3° C) or higher