Mediastinoscopy — Procedure Guide, Recovery & Risks | MyMedicPlus

Mediastinoscopy is a minimally invasive surgical procedure that examines and biopsies lymph nodes and masses in the mediastinum (the space between the lungs) through a small incision at the base of the neck.

Indicated for staging of lung cancer (N2/N3 nodal assessment), diagnosis of mediastinal lymphoma, sarcoidosis, thymoma, and enlarged mediastinal lymph nodes of uncertain cause detected on CT or PET scanning.

A 2–3 cm incision is made at the suprasternal notch. A mediastinoscope passes down the pretracheal fascia into the superior mediastinum. Lymph nodes from stations 2R, 2L, 4R, 4L, and 7 are biopsied under direct vision.

Most patients go home the same day or after one night. A pressure dressing covers the incision for 24 hours. Light activities resume in 3–5 days; strenuous activity avoided for 2 weeks. Brief voice hoarseness may occur.

Serious but rare complications affect fewer than 2% of patients and include haemorrhage from great vessels, recurrent laryngeal nerve injury causing hoarseness, pneumothorax, oesophageal perforation, and airway injury.

Mediastinoscopy provides tissue diagnosis in 90–95% of cases with mediastinal lymphadenopathy. In lung cancer staging, negative mediastinoscopy accurately predicts N0/N1 disease in 95% of patients, guiding resectability.