Mediastinoscopy has traditionally been the gold standard for assessing whether cancer has gone to the mediastinal lymph nodes (mediastinum is the space between the lungs that contains the heart, esophagus and airway). Mediastinoscopy is also used to biopsy a mediastinal mass or enlarged lymph nodes to check for an infectious process and may be used after chemotherapy and/or radiation to restage cancer.
New technology with the endobronchial ultrasound (EBUS) may be done first to reach the lymph nodes or mass; however, if this is not accomplished with EBUS, a video mediastinoscopy will be done.
For a mediastinoscopy, the patient is asleep under general anesthesia. A two to three centimeter incision is made above the collar bone.
A slender scope is placed through the incision and navigates several centimeters down into the mediastinum. From this location an enlarged image of the mediastinum is transmitted onto a large flat screen where the thoracic surgeon is able to view it.
Lymph nodes are examined and carefully dissected away. These lymph nodes are sent to a pathologist (a physician who specializes in examining and diagnosing tissue in the body).
During surgery, a pathologist may be able to give a tentative diagnosis by examining some of the tissue. A definitive report will typically be sent to the thoracic surgeon and other participating physicians within 2-3 days.
Video mediastinoscopy is a minimally invasive procedure and patients will generally go home the same day of the procedure.