Mediastinoscopy

Why do I need a mediastinoscopy?

You might have this test to see if cancer cells have spread into the lymph nodes around the windpipe. Your doctor can take ​biopsies​ if they see any abnormal areas.

Preparing for your mediastinoscopy

You might have a pre operative assessment appointment before your test operation. The assessment is to make sure you are well enough to have the anaesthetic. It is also to give you information on how to prepare for your test. 

You usually see a doctor and a nurse before your test. Your doctor will explain the procedure and ask you to sign a consent form. You will also need some other tests before the procedure, this can include:

• blood tests

• a chest x-ray

• a heart trace (ECG)

• tests to check that your lungs are working properly

• measuring your weight, blood pressure, temperature, heart and breathing rate

Before an anaesthetic

You need to stop eating and drinking a few hours before the test. Your healthcare team will tell you exactly when you should do this. 

Tell your doctor or nurse if not eating might be a problem for you, for example, if you have diabetes.

Let them know if you're taking medicines that change how your blood clots. This includes:

• aspirin

• clopidogrel

• arthritis medicines

• warfarin or heparin

• apixaban or rivaroxaban

You might need to stop taking this type of medicine a number of days before your mediastinoscopy. Your doctor or nurse will tell you when you should stop. They will also tell you if you need to stop taking other medicines.

What happens?

When you arrive a nurse will check your weight, blood pressure, temperature, heart and breathing rate. The nurse will also ask you to:

• change into a hospital gown

• take off any jewellery (except for a wedding ring)

• take off makeup, including nail varnish

• remove contact lenses and false teeth

You may be able to keep your false teeth in until you get to the anaesthetic room. They may also ask you to wear special stockings on your legs. These help to prevent blood clots forming. 

You meet the doctor who will explain the procedure and ask you to sign a consent form, if you have not done this before. This is a good time to ask any questions you may have.

Because you are having a general anaesthetic you will also meet the anaesthetist. They look after you while you are asleep.

You might have a medicine to make you feel drowsy before you go to the operating theatre. You need to stay in bed after you have had this.

Your nurse takes you to the operating theatre when it's time for your test.

During the test

The anaesthetist puts a small tube called a cannula into a vein in the back of your hand. Then they give you the anaesthetic medicine through the tube.

When you are asleep, your doctor makes a small cut at the lower part of your neck. They then put a long, thin, flexible tube called a mediastinoscope through the cut and into the mediastinum. 

A camera at the end of the tube connects to a large screen so the doctor can see pictures of the inside of your chest. They can examine the area between your lungs and take tissue samples (biopsies) if needed.

If you have a biopsy your doctor sends the tissue samples for examination under a microscope. This is to see if there are any cancer cells.

After your mediastinoscopy

You wake up in the recovery room, where you are looked after until you wake up properly from the anaesthetic. You might have an oxygen mask over your nose and mouth for a while. You may have a drip giving fluids into a vein until you can eat and drink normally. You might also have a chest x-ray.

When you go back to the ward, your nurse will continue to check and monitor you. 

The cut on your neck is closed with stitches. These may be dissolvable. This means they don't need to be removed. Or you may have stitches that need removing. The wound is then covered with a dressing. Your nurse will tell you how to look after the wound and when you can take your dressing off. They will also let you know if you need an appointment to remove the stitches. 

Soreness and pain

You might have some pain in your chest area. Your nurses will give you painkillers. Taking them for a few days helps. You might also have a sore throat. This is because you have had a tube in your throat to help you breathe during the test.

Tell your nurse or doctor if the pain goes on for more than a few days.

Eating and drinking

Once you are fully awake, you are usually able to eat and drink. Your nurse will let you know when you can do this.

Going home

When the anaesthetic has worn off, you can go home. This might be on the evening of the test or the next day.

As you’re having a general anaesthetic you’ll need someone with you. This is so they can take you home and stay with you overnight. For 24 hours after having a general anaesthetic you shouldn’t:

• drive

• drink alcohol

• operate heavy machinery

• sign any legally binding documents

Possible risks

A mediastinoscopy is a very safe procedure. Your nurse will tell you who to contact if you have any problems after your test. Your doctors will make sure the benefits of having a mediastinoscopy outweigh any possible risks.

Some of the possible risks include:

Bleeding

There is a risk of bleeding from the wound, or inside the mediastinum. Contact your hospital 24 hour advice line if your wound starts to bleed, you have chest pain or if your breathing gets worse.

You might need further surgery if your doctor thinks you have some bleeding in the mediastinum.

Infection

Contact your hospital 24 hour advice line if your wound is red and feels hot. Or if you have a liquid (discharge) leaking from your wound. You must also let them know if you have a high temperature or feel feverish. Your nurse will give you information on what to look for and who to contact if you are concerned you might have an infection.

A hoarse voice

You might have a hoarse voice if the test has injured the nerves that go to the voice box. Your voice normally goes back to normal over a few weeks. But a few people have a permanent voice change.

Air leaking from the lung

It is rare to have an air leak from the lung or a collapsed lung. Contact your 24 hour hospital advice line straight away if you have:

• shortness of breath

• swelling of the neck

• chest pain

• difficulty swallowing

It is important to treat a collapsed lung straight away. Your doctor will put a tube into the lung for a few days until the lung expands again.

Damage to the food pipe

You might have a tear in the food pipe (oesophagus). This is a rare complication. If this happens, you might have surgery to repair the tear.