Mediastinoscopy is a surgical procedure that is used for diagnostic purposes through a minimally invasive procedure. The goal of this examination is to exclude or detect disease in the chest area, the mediastinum, and to identify the stage of the disease. It is a procedure for imaging and sampling of possible pathological tissue structures.
What is mediastinoscopy?
During a mediastinoscopy, an endoscope is used to examine the mediastinum. This is part of the chest and is composed of the trachea, esophagus, part of the heart and various nerves that run there. Mediastinoscopy is a surgical procedure for imaging and diagnosis. However, based on the technique, anatomical structures can also be dissected and completely removed, such as individual lymph nodes. Using an endoscope, the mediastinum is examined. This is part of the chest and consists of the trachea, esophagus, part of the heart and various nerves running through it. In addition, lymph nodes and the sweetbreads are also located in the area of the mediastinum. The sweetbread, also known by the synonym thymus, is an organ of the lymphatic system that belongs to the immune system. Today, mediastinoscopy is performed as a so-called video mediastinoscopy. By using this technique, the area to be examined can be reproduced on a monitor and improves visibility, as individual areas can be magnified up to 15 times. The anatomical structures of the middle posterior mediastinum can thus be viewed much better and more clearly. In classical mediastinoscopy, only the surgeon can view the chest area via the instrument, the mediastinoscope. Contributors in the assistance did not have a view of the surgical procedure.
Function, effect, and goals
Mediastinoscopy is almost always performed for the purpose of diagnosis and is usually not used to treat possible diseases. The goal of mediastinoscopy is to evaluate a disease, diagnose it, and, if necessary, determine its stage and extent. The result of the procedure is of high importance for the further course of the patient’s treatment. Before this procedure is performed, preliminary examinations such as magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), or chest X-ray should be performed. If the previous diagnostic procedures are not informative or show enlargements of the lymph nodes between the two lung lobes, a mediastinoscopy becomes necessary. During a mediastinoscopy, the surgeon can thus project more revealing images with an endoscope and take tissue samples. The procedure takes place under a brief general anesthetic. A small incision must be made above the sternum. Through the incision, the mediastinoscope is carefully guided parallel to the trachea (windpipe) to the front of the mediastinum. The mediastinoscope is a special instrument designed for this purpose, which consists of a small tube with a camera and a suction cup. The surgeon and assistants can follow the surgical procedure on the monitor. The surgeon can get an exact overview and perform a biopsy. For this purpose, a small forceps is inserted into the mediastinum via the tube of the mediastinoscope and small tissue samples of the affected area are plucked. The fine tissue structures taken are presented to the pathologist for examination. With the help of a microscope, the pathologist can test the removed samples and make a statement about the type and location of the so-called parent tumor. This type of diagnosis is used for diseases of the lung and mediastinum, such as sarcoidosis, lung cancer, lymphoma or involvement of the lymph nodes. Furthermore, types of certain infections of the lung, such as tuberculosis, can be detected or excluded. Basically, this endoscopic diagnosis is necessary when changes to organs in the chest area are present or suspected. Affected areas may include the lungs, diaphragm, organs of the immune system, trachea and esophagus, and lymph nodes.Fluid accumulations in the pleura or pericardium, which may be watery or purulent, lung tumors (e.g. bronchial carcinoma), sarcoidosis (Boeck’s disease or Schaumann-Besnier’s disease), malignant lymphoma or a diffusely growing tumor (mesothelioma) should be detected. If there is a suspicion by the symptomatology and previous examination of such a disease, this procedure should be performed by an experienced specialist.
Risks, side effects, and hazards
If mediastinoscopy is performed correctly by a specialist, it carries few risks and complications rarely occur. Very rarely, temporary or permanent nerve damage may occur. In isolated cases, injury to the organs of the mediastinum may occur. As a result, bleeding, secondary bleeding or sensory disturbances may occur. Cardiac arrhythmias and temporary impairment of the vocal cords can also occur as complications. Injuries to the trachea and esophagus require suturing, and leaks may occur. In very rare cases, pneumothorax may occur. After the procedure, a complete follow-up should be performed. Any side effects that occur, such as fever, bleeding from the surgical wound, chest pain or shortness of breath, should be reported to the specialist immediately. However, swallowing difficulties, swelling in the throat and hoarseness, even loss of voice, are also serious side effects. Before the operation, medications that have a negative effect on blood clotting should be discontinued or taken only after consultation with the attending physician. Taking such medications increases the risk of severe bleeding during and after mediastinoscopy. Smoking and the consumption of alcohol before and after the procedure can lead to wound healing problems. To remedy short- and long-term side effects and consequences, physiotherapeutic breathing exercises should be performed postoperatively. The prognosis and further course of treatment depend on the particular findings that produced the mediastinoscopy and are discussed with the treating physician afterwards.
