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Mediastinoscopy and Mediastinotomy

By

Rebecca Dezube

, MD, MHS, Johns Hopkins University

Last full review/revision May 2021| Content last modified May 2021
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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.

The two procedures are complementary. Mediastinotomy gives direct access to aortopulmonary window lymph nodes, which are inaccessible by mediastinoscopy.

Indications

Both mediastinoscopy and mediastinotomy are done to evaluate or excise mediastinal lymphadenopathy or masses and to stage cancers (eg, lung cancer, esophageal cancer), although positron emission tomography (PET) scanning and endobronchial ultrasound-guided transbronchial needle aspiration are decreasing the need for these procedures for cancer staging.

Contraindications

Contraindications mediastinoscopy and mediastinotomy include the following:

  • Aneurysm of the aortic arch

  • Previous median sternotomy

  • Previous mediastinal irradiation

  • Superior vena cava syndrome

  • Tracheostomy

Procedure

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

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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