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 Positron emission tomography (PET) Chest imaging includes use of plain x-rays, computed tomography (CT) scanning, magnetic resonance imaging (MRI), nuclear scanning, including positron emission tomography (PET) scanning, and... read more 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
