Mediastinoscopy
Indications
- Biopsy of mediastinal mass / node - sarcoid, lymphoma, mediastinal tumours, TB
- Staging of primary lung cancer
Relative risks
- Bleeding - from azygos vein, antero-apical branch of right pulmonary artery
- Infection
- Pneumothorax
- Tracheal injury
- Injury to oesophagus
- Recurrent laryngeal nerve injury (most common on left)
Other procedures:
- Thoracotomy
- Median sternotomy
CERVICAL Procedure:
Access: stations 2,3,4, 7 (para and pre-tracheal regions)
- Supine with sandbag between shoulders with neck fully flexed
- 3cm transverse incision midway between supra-sternal notch and thyroid cartilage
- Dissection through investing fascia, strap muscles in midline
- Retract thyroid superiorly (care to avoid injury to inferior thyroid vessels)
- Open pre-tracheal fascia and bluntly dissect off anterior trachea
- Pass mediastinoscope in front of trachea, BEHIND pre-tracheal fascia BENEATH the innominate artery
Left / Right anterior Mediastinoscopy
Access: stations AP window, hilum
- Position supine with side elevated to 30 degreees
- 4cm incision along (left / right) sternal border
- Dissect through muscles avoiding internal thoracic vessels
- Avoid entering the pleura by blunt dissection of pleura down
