Mediastinoscopy and Mediastinotomy

ByRebecca Dezube, MD, MHS, Johns Hopkins University
Reviewed/Revised Nov 2023
View Patient Education

Mediastinoscopy is a procedure in which an endoscope is introduced through the suprasternal notch into the mediastinum to allow visualization of it. Mediastinotomy is surgical opening of the mediastinum.

Mediastinoscopy and mediastinotomy are complementary. Mediastinotomy gives direct access to aortopulmonary window lymph nodes, which are inaccessible by mediastinoscopy.

Indications for Mediastinoscopy and Mediastinotomy

Both mediastinoscopy and mediastinotomy are done to ,

  • Evaluate or excise mediastinal lymphadenopathy or masses

  • Stage cancers (eg, lung cancer, esophageal cancer)

Positron emission tomography (PET) scanning and endobronchial ultrasound-guided transbronchial needle aspiration have decreased the need for mediastinoscopy or mediastinotomy in cancer staging.

Contraindications to Mediastinoscopy and Mediastinotomy

Contraindications to mediastinoscopy and mediastinotomy include the following:

  • Aneurysm of the aortic arch

  • Previous median sternotomy

  • Previous mediastinal irradiation

  • Superior vena cava syndrome

  • Tracheostomy

Procedure for Mediastinoscopy and Mediastinotomy

Mediastinoscopy and mediastinotomy are done by surgeons in an operating room using general anesthesia.

For mediastinoscopy, an incision is made in the suprasternal notch, and the soft tissue of the neck is bluntly dissected down to the trachea and distally to the carina. A mediastinoscope is inserted into the space, allowing access to the paratracheal, tracheobronchial, azygous, and subcarinal nodes and to the superior posterior mediastinum.

Anterior mediastinotomy (the Chamberlain procedure) is surgical entry to the mediastinum through an incision in the parasternal 2nd left intercostal space, allowing access to anterior mediastinal and aortopulmonary window lymph nodes, common sites of metastases for left upper lobe lung cancers.

Complications of Mediastinoscopy and Mediastinotomy

Complications occur in < 1% of patients and include

  • Bleeding

  • Chylothorax due to lymphatic duct injury

  • Esophageal perforation

  • Infection

  • Pneumothorax

  • Vocal cord paralysis due to recurrent laryngeal nerve damage

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