Mediastinoscopy is an endoscopic technique for examining the mediastinum by making an incision in the tissues in the neck to insert a mediastinoscope into it. Mediastinoscopy with biopsy helps specialists perform microscopic examination of human tissue samples to detect cancer, inflammatory and infectious processes. Often, mediastinoscopy uses other biopsy techniques – using computed tomography, echocardiography, or bronchoscopy.
Indications and contraindications
Mediastinoscopy is necessary for specialists to perform a biopsy of the bifurcation or paratracheal lymph nodes of the mediastinum. In an extended version, diagnostics is used when performing a biopsy of bronchopulmonary lymph nodes, as well as lung tissue, to verify the cause of intrathoracic adenopathy, to determine the presence of lung cancer metastases in these lymph nodes in order to clarify the stage of oncological disease, to diagnose the degree of damage to mediastinal lymph nodes or lung tissue in the process of ongoing disseminated lung processes.
Sometimes this diagnostic technique allows you to remove paratracheal cysts and cyst-like neoplasms, as well as small thymomas. For extended mediastinoscopy, experts also name such indications as cancer of the upper, middle or lower third of the patient’s esophagus.
Most often, this analysis in the medical environment is prescribed for the diagnosis of sarcoidosis, lymphoma, tuberculosis, as well as for the selection of the optimal type of treatment in a particular case – surgery, chemotherapy or radiation.
The main contraindication for the appointment of mediastinoscopy is 4-5 degree of enlargement of the thyroid gland, a pronounced syndrome of the superior vena cava, since this can provoke profuse venous bleeding.
procedure hardware
In general, mediastinoscopy is a surgical or surgical intervention performed using special surgical instruments – a scalpel, hemostatic clamps, tweezers, tupfers, hooks, and more.
Due to the fact that, as with any other surgical intervention, severe bleeding may occur with mediastinoscopy, the surgeon will need napkins and swabs from hemostatic gauze.
The anterior mediastinum and its organs after the incision are examined using a mediastinoscope, in which light is supplied using a fiberglass light guide, and an aspirator mounted inside the apparatus helps to remove blood from the wound without interference in the field of view.
When conducting extended mediastinoscopy, a mediastinoscope with a blade up to 250 millimeters in diameter is used, shaped like a truncated cone.
The main danger for the surgeon during this procedure is the possibility of injuring large arteries, thus causing severe bleeding. In this aspect, the specialist should always be prepared for emergency thoracotomy and mediastinotomy, having on a separate surface the surgical instruments and dressings necessary for the above procedures.
Preparing and conducting analysis
On the eve of the mediastinoscopy, the patient should discuss in detail all his concerns with the doctor and sign the consent to the procedure. If there are cancer cells in the lymph nodes, the surgeon can immediately remove them during the analysis, but this issue must be agreed with the patient in advance.
On the eve of the mediastinoscopy, it is imperative to notify the doctor that:
- are taking or have taken any medications;
- there is an allergy to some drugs, including anesthesia drugs;
- there is a problem of blood clotting;
- there is a pregnancy;
- previously underwent open-heart surgery (scars from such a surgical intervention can become an obstacle to the procedure);
- previously there was hyperextension or various injuries in the neck;
- there are any congenital diseases;
- radiation therapy was transferred.
The mediastinoscopy procedure is performed under general anesthesia. To prepare for the study, the patient must refuse to eat in advance – at least 6 hours, and from drinking – 2 hours before the procedure. Remove all metal jewelry and remove all objects of a different nature – dentures, glasses, contact lenses. Pass all tests prescribed by a specialist, the results of which are important to the doctor before the procedure.
Mediastinoscopy is carried out by the surgeon and assistants. After intravenous anesthesia, the patient is put on an oxygen mask to facilitate breathing, the incision is treated with an antiseptic and covered with a sterile film for protection.
The incision itself is made either in the area above the sternum, or at the base of the neck, or on the left side of the chest between the 4th and 5th ribs. A mediastinoscope is inserted into it, and an examination begins, carried out in the area between the patient’s lung and heart. For examination, the specialist takes the lymph nodes or pathological tissue. Upon completion of the study, sutures and bandage structures are applied to the incision.
The procedure takes the doctors about an hour. After that, patients are placed in the recovery room, where some of them must remain for some time (as prescribed by doctors), and some can go home immediately after coming out of anesthesia. The stitches can be removed after 2 weeks, after which a very small scar remains on the body.
Since mediastinoscopy is performed under general anesthesia, the patient does not experience pain during it. On the eve, doctors often give patients to take sedatives to calm them down. After coming out of anesthesia, patients may feel sleepy and tired for several days, which is not a sign of pathology. The resulting sore throat is recommended to be eliminated by rinsing with salt water.
It is extremely rare that complications occur after mediastinoscopy, but sometimes pneumothorax, bleeding, infectious diseases, ruptures of the esophagus, damage to blood vessels or nerves near the larynx, and dysphonia may occur. Therefore, the patient urgently needs to go to the hospital if, after the procedure, bleeding at the suture site, fever, severe chest pain, swelling of the neck, shortness of breath, difficulty in swallowing or dysphonia began to be observed.
In medical practice, normal indicators during mediastinoscopy are smooth and not enlarged lymph nodes, the absence of pathologies in tissues, growths or symptoms of infectious diseases.
In this case, pathologies include enlarged lymph nodes, which indicate sarcoidosis, cancer, infectious diseases, pathological neoplasms, abscess. At the same time, when cancer cells are detected, their immediate surgical removal during the procedure is possible. If such an intervention was not immediately performed, the specialists prescribe the operation at a later time, which is determined after a laboratory study of all tissue samples taken.