Name of the Procedure:

Mediastinoscopy with lymph node biopsy(ies) (e.g., lung cancer staging)

Summary

Mediastinoscopy is a minimally invasive surgical procedure used to examine and take tissue samples from the mediastinal lymph nodes located between the lungs. This procedure is commonly used to help stage lung cancer or diagnose other conditions affecting the chest.

Purpose

Mediastinoscopy is primarily employed to:

• Stage lung cancer by determining the extent of cancer spread to the lymph nodes.
• Diagnose conditions such as infections, inflammatory diseases, or lymphomas affecting the mediastinal lymph nodes. The goal is to gather enough information to make an accurate diagnosis and plan the most effective treatment.

Indications

• Persistent coughing, weight loss, or unexplained fever.
• Abnormal chest X-rays or CT scans suggesting lymph node enlargement or masses in the mediastinum.
• Suspected lung cancer requiring staging for treatment planning.
• Diagnosis of mediastinal diseases like sarcoidosis or tuberculosis.

Preparation

• Patients are usually instructed to fast for 6-8 hours before the procedure.
• Certain medications such as blood thinners might need to be adjusted or temporarily stopped.
• Pre-procedure diagnostic tests, including blood tests, EKG, and imaging studies like a chest CT scan, may be required.

Procedure Description

1. The patient is brought to the operating room and given general anesthesia to ensure they are asleep and pain-free.
2. A small incision is made at the base of the neck.
3. A mediastinoscope, a thin, tube-like instrument with a camera and light, is inserted through the incision to visualize the mediastinal area.
4. Lymph node biopsies are obtained using special instruments passed through the mediastinoscope.
5. The mediastinoscope is removed, and the incision is closed with stitches.
6. The tissue samples are sent to a lab for examination.

Duration

The procedure typically takes 60 to 90 minutes.

Setting

Mediastinoscopy is typically performed in a hospital operating room or a specialized surgical center.

Personnel

• Thoracic surgeon or surgical oncologist
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Common risks: bleeding, infection, and temporary hoarseness due to nerve irritation.
• Rare complications: injury to surrounding structures (e.g., blood vessels, trachea), and pneumothorax (collapsed lung).

Benefits

• Provides crucial information for accurate lung cancer staging and diagnosis of other mediastinal conditions.
• Offers reliable tissue samples, leading to precise treatment planning.
• Quick recovery compared to more invasive surgical procedures.

Recovery

• Patients may need to stay in the hospital for a few hours to overnight for observation.
• Post-procedure instructions include managing the incision site, avoiding strenuous activities, and monitoring for signs of infection.
• Recovery generally takes about 1-2 weeks, with follow-up appointments to discuss biopsy results.

Alternatives

• Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)
  • Pros: Less invasive, performed via the airway.
  • Cons: May provide less extensive lymph node sampling.
• Video-assisted thoracoscopic surgery (VATS)
  • Pros: Provides more comprehensive access to the chest.
  • Cons: More invasive with longer recovery time.
• Watchful waiting and repeat imaging for non-urgent cases.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not experience any sensation.
• After the procedure, pain at the incision site is common and can be managed with prescribed analgesics.
• Patients may feel some soreness and discomfort in the throat from the anesthesia.
• Follow-up is essential to receive biopsy results and plan further treatment if necessary.