Treatments & Therapies

Mediastinoscopy – Treatment, Effects & Risks

Mediastinoscopy

mediastinoscopy is a surgical surgical procedure that is used by a minimally invasive procedure for diagnostics. The aim of this examination is to exclude or detect diseases in the chest area, the mediastinum, as well as to identify the stage of the disease. It is a procedure for imaging and removal of possible pathological tissue structures.

What is mediastinoscopy?

Mediastinoscopy is a surgical procedure for imaging and diagnostics. Based on the technique, however, anatomical structures can also be prepared and completely removed, such as individual lymph nodes.

By means of an endoscope, the mediastinum is examined. This is part of the thorax and consists of the tracheaesophagus, part of the heart and various nerves running there. In addition, lymph nodes and the bries are also located in the area of the mediastinum. Bries, 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 inspected can be displayed on a monitor and improves the view, 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 see the chest area via the instrument, the mediastinoscope. Assistants had no insight into the operation.

Function, impact & goals

Mediastinoscopy is almost always performed for the purpose of diagnostics and is usually not used to treat possible diseases. The aim of mediastinoscopy is to assess a disease, diagnose it and, if necessary, determine its stage and extent. The result of the procedure is of great importance for the further course of treatment of the patient. 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 lungs, a mediastinoscopy becomes necessary.

In a mediastinoscopy, the surgeon can use an endoscope to project revealing images and take tissue samples. The procedure takes place under a short general anesthesia. A small incision must be made above the sternum. Through the incision, the mediastinoscope is carefully guided parallel to the trachea (trachea) to the mediastinum. The mediastinoscope is a special instrument provided for this purpose, which consists of a small tube with a camera and a vacuum cleaner. On the monitor, the surgeon and the assistants can follow the operation.

The surgeon can get a precise overview and perform a biopsy. For this purpose, a small pair of pliers is inserted into the mediastinum via the tube of the mediastinoscope and small tissue samples of the affected area are plucked off. The finely extracted tissue structures are presented to the pathologist for examination. With the help of a microscope, he can test the samples taken and make a statement about the tumor type and location of the so-called mother tumor.

This type of diagnosis is used for diseases of the lungs and mediastinum, such as sarcoidosislung cancer, lymphoma or involvement of the lymph nodes. Furthermore, types of certain infections of the lungs, such as tuberculosis, can be detected or excluded. Basically, this endoscopic diagnosis is necessary if changes in organs in the chest area are present or suspected. Affected areas can be the lungs, diaphragm, organs of the immune system, trachea and esophagus, as well as lymph nodes.

There are fluid accumulations in the pleura or pericardium, which may be watery or purulent, lung tumours (e.g. bronchial carcinoma), sarcoidosis (Boeck’s disease or Schaumann-Besnier’s disease), malignant lymphoma or a diffusely growing tumour (mesothelioma). If there is a suspicion due to the symptoms and the previous examination of such a disease, this procedure should be carried out by an experienced specialist.

Risks, side effects & dangers

If a mediastinoscopy is performed correctly, it carries few risks and complications rarely occur. Very rarely, temporary or permanent nerve damage can occur. In individual cases, there may also be injuries to the organs of the mediastinum. This can cause bleeding, secondary bleeding or sensory disturbances.

Cardiac arrhythmias and temporary impairment of the vocal cords can also occur as complications. Injuries in the area of the trachea and esophagus need to be sutured, it can lead to leaks. In very rare cases, pneumothorax may occur. After the procedure, a complete follow-up should be carried out.

Occurring side effects such as fever, bleeding from the surgical wound, pain in the chest area or shortness of breath should be reported to the specialist immediately. But also difficulty swallowing, swelling in the throat and hoarseness up to loss of voice are serious side effects.

Before surgery, medications that have a negative effect on blood clotting should be discontinued or taken only after consultation with the attending physician. When taking such drugs, the risk of heavy bleeding during and after mediastinoscopy increases. Smoking and the consumption of alcohol before and after the procedure can lead to wound healing disorders.

In order to remedy short- and long-term side effects and consequences, physiotherapeutic breathing exercises should be performed postoperatively. The prognosis and the further course of treatment depends on the respective findings of the mediastinoscopy and is subsequently discussed with the attending physician.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.