Mediastinoscopy is a procedure that enables visualization of the contents of the

mediastinum The mediastinum (from ) is the central compartment of the thoracic cavity. Surrounded by loose connective tissue, it is an undelineated region that contains a group of structures within the thorax, namely the heart and its vessels, the esophagu ...

, usually for the purpose of obtaining a

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...

. Mediastinoscopy is often used for staging of

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that inclu ...

s of

lung cancer Lung cancer, also known as lung carcinoma (since about 98–99% of all lung cancers are carcinomas), is a malignant lung tumor characterized by uncontrolled cell growth in tissue (biology), tissues of the lung. Lung carcinomas derive from tran ...

or for diagnosing other conditions affecting structures in the mediastinum such as

sarcoidosis Sarcoidosis (also known as ''Besnier-Boeck-Schaumann disease'') is a disease involving abnormal collections of inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph nodes. Less commonly af ...

lymphoma Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). In current usage the name usually refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enlar ...

. Mediastinoscopy involves making an incision approximately 1 cm above the

suprasternal notch The suprasternal notch, also known as the fossa jugularis sternalis, jugular notch, or Plender gap, is a large, visible dip in between the neck in humans, between the clavicles, and above the manubrium of the sternum. Structure The suprasternal ...

of the

sternum The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Sh ...

, or breast bone. Dissection is carried out down to the pretracheal space and down to the

carina Carina may refer to: Places Australia * Carina, Queensland, a suburb in Brisbane * Carina Heights, Queensland, a suburb in Brisbane * Carina, Victoria, a locality in Mildura Serbia * Carina, Osečina, a village in the Kolubara District ...

. A scope (

mediastinoscope A mediastinoscope is a thin, tube-like instrument used to examine the tissues and lymph nodes in the area between the lungs (mediastinum) in a procedure known as mediastinoscopy. These tissues include the heart and its large blood vessels, trachea, ...

) is then advanced into the created tunnel which provides a view of the mediastinum. The scope may provide direct visualization or may be attached to a video monitor. Mediastinoscopy provides access to mediastinal lymph node levels 2, 4, and 7.

Current use

Historically, mediastinoscopy has been the gold standard for the staging of lung cancer. However, with advances in minimally invasive procedures and imaging, mediastinoscopy usage has declined significantly from 2006 to 2010.

Extended mediastinoscopy

Extended mediastinoscopy is a technique which allows access to the pre-aortic (station 6) and

aortopulmonary window Aortopulmonary window (APW) refers to a congenital heart defect similar in some ways to persistent truncus arteriosus. Persistent truncus arteriosus involves a single valve; aortopulmonary window is a septal defect A congenital heart defect (C ...

(station 5) lymph nodes.

Parasternal mediastinotomy

Parasternal mediastinotomy, aka, a Chamberlain procedure, is the standard approach to access lymph nodes at stations 5 and 6.

References

{{Endoscopy Thoracic surgical procedures Endoscopy Pulmonary thoracic surgery