About Your Mediastinoscopy

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

Figure 1. Mediastinum

A mediastinoscopy is a procedure in which your doctor 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 surgeon will make a small incision (surgical cut) in the middle of your lower neck. They will place a metal tube with a light and 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 your chest or to look at lymph nodes that are larger than normal. 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.

Getting Ready for Your Procedure

Ask about your medications

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.

  • Vitamin E
    Stop taking vitamin E 10 days before your procedure. Vitamin E can increase your risk of bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
  • Aspirin
    Stop taking aspirin 7 days before your procedure, if your doctor or nurse tells you to. Aspirin and medications that contain aspirin can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
  • Herbal remedies and supplements
    Stop taking any herbal remedies and supplements 7 days before your procedure, because they can cause bleeding. If you take a multivitamin, ask your doctor or nurse if you should continue. For more information, read Herbal Remedies and Cancer Treatment.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    Stop taking NSAIDs such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®) 2 days before your procedure. These medications can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs). If you have pain or discomfort, take acetaminophen (Tylenol®). Don’t take more acetaminophen than directed on the label or as instructed by your doctor.
  • Anticoagulants (blood thinners)
    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:
    • apixaban (Eliquis®)
    • aspirin
    • clopidogrel (Plavix®)
    • dabigatran (Pradaxa®)
    • enoxaparin (Lovenox®)
    • heparin
    • rivaroxaban (Xarelto®)
    • warfarin (Coumadin®)
    Speak with your surgeon and the doctor who prescribed the medication to determine when to stop.
  • Medications for diabetes
    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 about what you should do the morning of your procedure.

For instructions about what medications you can take on the morning of your procedure, talk with your surgeon.

Get a letter from your doctor, if necessary

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

Arrange for someone to take you home

You must have someone 18 years or older take you home after your procedure. If you don’t have someone to do this, call one of the agencies below. They will send someone to go home with you. There’s usually a charge for this service, and you will need to provide transportation.

Agencies in New York                                         Agencies in New Jersey
Partners in Care: 888-735-8913                                         Caring People: 877-227-4649
Caring People: 877-227-4649                                          

 

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The Day Before Your Procedure

Note the Time of Your Surgery

A clerk from the Admitting Office will you after 2:00 pm on the day before your procedure. The clerk 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 don’t receive a call by 7:00 pm, call 212-639-5014.

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

Instructions for eating and drinking before your surgery

12 ounces of water
  • Do not eat anything after midnight the night before your surgery. 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.
 
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The Day of Your Procedure

Things to remember

  • Take only the medications your doctor 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 located on East 66th Street between York and First Avenues. If you have questions about prices, call 212-639-2338.

To reach the garage, turn onto 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 connects the garage to the hospital.

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.

 

Where to go

Please go to the main building of MSK, located at 1275 York Avenue between East 67th and East 68th Streets. Once you’re there, go to the Presurgical Center on the 2nd floor. To get there, take the M elevator to the 2nd floor.

Once you’re in the hospital

Once you arrive at the hospital, you will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having procedures on the same day.

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

You will meet with your nurse before your procedure. Your 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. Your nurse will also check your blood pressure, pulse, temperature, and breathing.

You will also meet with your doctor before your procedure. They will explain the procedure to you and answer any questions you may have. They will ask you to sign a consent form, if you haven’t already.

When it’s time for your procedure, you will 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 will 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 will 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 immediately, 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.

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After Your Procedure

What to expect in the hospital

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

You will receive oxygen through a thin tube that rests below your nose called a nasal cannula. A nurse will be monitoring your temperature, pulse, blood pressure, and oxygen levels. They will also check the dressing around your incision. You will 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 will stay in the PACU until you’re fully awake and your doctor 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 doctor ordered. They will 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 doctor 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 doctor’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 prescribed by your doctor. If you’re allergic to acetaminophen, ask your doctor 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 may remove your dressing.
  • You may shower 24 hours after your procedure. Remember to leave the Steri-Strips in place. Apply soap and water gently to the area. Leave the Steri-Strips on your incision. If they haven’t fallen off in 3 days, you can 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.

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Call Your Doctor or Nurse 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 temperature of 101° F (38.3° C) or higher
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