Mediastinoscopy

Definition

Inside are the heart, airways (trachea and main bronchi), esophagus, nerve structures, lymph nodes and large vessels such as the aorta and vena cavae. In the mediastinum, processes can be located inflammatory, infectious and tumorous.

For the study of this structure, the use of imaging tests such as tomography or magnetic resonance imaging is useful, but sometimes they are insufficient and a direct visualization of the mediastinum and the taking of tissue samples is necessary to complete the diagnosis. Mediastinoscopy is a Surgical technique that manages to visualize all the structures contained in said space. The mediastinoscope is the medical instrument specially designed for this examination.

It is made up of a flexible tube with a millimeter camera and a light source at its distal end. Inside the tube there is a path that allows the introduction of special forceps for taking biopsies.

How is the study done?

It is carried out in the hospital setting. Requires admission and operating room for its realization. Sedative drugs can be administered to reduce anticipatory anxiety. Once in the operating room, the anesthetic process is completed. To access the mediastinum, an incision of about 3 cm in length is made above the sternum. The mediastinoscope is inserted through this incision. It is possible that in the event of a significant finding, a biopsy.

The tissue obtained will be sent to the corresponding laboratories to complete its study. Once the intervention is finished, the patient will remain in an observation area. The study usually lasts approximately 45-60 minutes, although hospital discharge is not usually given until 24 hours after the intervention.

Preparation for the study

It requires a previous fast of at least 6 hours. It is a surgical process so you must have a preoperative study. The previous tests are electrocardiogram, chest x-ray and laboratory tests blood with coagulation tests.

What does it feel like during and after the study?

During the procedure the patient will not feel anything because it is performed under general anesthesia. After the intervention, you may have pain in the incision area or even a slight sore throat due to oropharyngeal intubation during anesthesia. These annoyances are easily controllable with conventional painkillers.

Study risks

Mediastinoscopy presents the risks derived from the anesthetic technique and those inherent to the procedure itself. The anesthetist must individually assess the anesthetic risk. This risk is usually higher in patients with a previous history of allergic reactions and other medical illnesses. The risks associated with mediastinoscopy are rare, although it is worth noting: dysphonia due to injury to the recurrent laryngeal nerve, pneumothorax, injury to the explored structures such as the esophagus and / or trachea, hemorrhage by breaking a glass or infection of the mediastinum.

Study contraindications

Intervention should be avoided in patients for whom the use of general anesthesia is contraindicated due to allergy to commonly used anesthetics.

There are some anatomical peculiarities of the patient that may also contraindicate the practice of mediastinoscopy and it should be the doctor who assesses the risk of the intervention. Among the situations that contraindicate the intervention, we find those that distort the anatomy of the mediastinum, such as an aneurysm of the thoracic aorta, an obstruction of the superior vena cava or a marked deviation of the trachea. These abnormalities can favor the damage of some structure at the time of performing the biopsy.

Reasons why the study is carried out

The physician responsible for the care may request a mediastinoscopy with the following indications:

• Diagnosis of inflammatory, infectious or tumor processes such as tuberculosis, sarcoidosis, lymphomas or mediastinal tumors.
• Establish the stage of lung cancer by studying the lymph nodes.
• Therapeutic to extract some mediastinal lesions.