What Is a Mediastinoscopy?

Medically Reviewed by Sabrina Felson, MD on July 23, 2022
4 min read

A mediastinoscopy helps doctors look at the space behind your breastbone in the middle of your chest, between your lungs. Experts call this area your “mediastinum.” It holds your heart and its large vessels, your trachea or windpipe, your esophagus, your thymus gland, and some of your lymph nodes.

This surgical procedure can help your doctor look for and locate problems related to lung cancer.

Your doctor might suggest a mediastinoscopy to take out some of your lymph nodes if you have lung cancer. They’ll then look under a microscope for lung cancer cells in the nodes to see if your cancer has spread outside of the lungs. This will help them decide on the best treatment for your lung cancer.

A mediastinoscopy can also help doctors find things like:

  • Cancer in your bronchi
  • Cancer in other areas of your mediastinum
  • Inflammation or infection
  • Sarcoidosis, which is a condition that leads to inflammation in organs such as your liver, lungs, or spleen
  • Lymphoma, or cancer that starts in your lymphatic system (such as Hodgkin's disease)
  • Thymoma, or a tumor in your thymus gland

Before your operation, tell your doctor about any medications you’re on. This includes any vitamins, herbs, or supplements. You should also tell them if you are allergic to any drugs.

Your medical team might suggest that you stop any blood-thinning medicines, like aspirin, before your operation. They might also ask you to not eat or drink several hours before your mediastinoscopy.

Your doctor will give you specific rules to follow. Make sure to ask any questions if you’re unsure about something.

Your doctor will use a tool called a mediastinoscope to perform your mediastinoscopy. This device is a thin, long, flexible tube with a very small camera and light. It helps your doctor see inside of your mediastinum. The tool will send pictures of your organs and other parts to a computer screen. It can also record a video of the inside of your mediastinum.

This surgical procedure usually happens in a hospital operating room. How long you stay in the hospital will depend on your condition and the methods your doctor uses.

Before a mediastinoscopy, you’ll first take off your clothes and put on a hospital gown. You’ll need to take off any jewelry or other accessories. Your doctor will have you lie on an operating table to do the procedure.

They’ll insert an intravenous (IV) line into your arm or hand. You’ll also get general anesthesia that will help you sleep through the operation. Your care team will put a breathing tube through your throat. This will be hooked up to a breathing machine called a ventilator. This will help your doctor watch your heart rate, blood pressure, and breathing during the operation.

Your doctor will trim any hair that you have on the area of surgery. They’ll also clean this area with an antiseptic solution.

Then, they’ll make a small cut right above your breastbone. They’ll create a passageway into your mediastinum and feel your lymph nodes to assess them.

Your doctor will put the mediastinoscope through the passageway. They may take tissue samples from your lymph nodes. Then, they’ll take out the mediastinoscope. Your doctor will close your skin with stitched or adhesive strips. Then, they’ll bandage up the area.

Overall, the surgery takes about an hour. But it could take longer in some situations.

After the surgery, your doctor will watch you closely to make sure you don’t develop any complications. You might feel dazed or confused after anesthesia. Your mouth and throat may also be numb for a few hours. It’s important not to eat or drink until this numbness wears off.

After the numbness is gone, you may have a cough, a sore throat, or be hoarse for a day or two. Pain in the areas that were cut is also common.

If your mediastinoscopy was an outpatient surgery, you’ll be able to go home after a few hours. But some people will stay in the hospital slightly longer. Make sure you’ve arranged to have someone pick you up. You won’t be able to drive after the medications or anesthesia.

Your health care team will give you instructions for what you are and aren’t able to do after your surgery. Make sure that you follow these carefully.

You will usually get your biopsy results within a week. These results will tell you if your lymph nodes show signs of cancer or infection. Ask your doctor when you’ll receive them, and plan to follow up after your surgery.

As with any surgery, there could be possible complications with a mediastinoscopy. Overall, the procedure is safe, but there’s a slight risk of:

Your medical team will look for any immediate complications from the surgery before you leave the hospital. These include things like a collapsed lung. They will also tell you what to look out for once you are home and when you should call your doctor. Usually, you’ll need to reach out if you have chest pain, a fever that doesn't go away, trouble breathing, or if you cough up blood. Make sure you understand what symptoms you need to call for.