What is it?
Mediastinoscopy is also known as cervical mediastinoscopy, or cervical
mediastinal exploration (CME). It is a minimally invasive operation
performed by a thoracic surgeon.
What is it used for?
Mediastinoscopy is used to biopsy or remove lymph nodes located
in the center of the chest, or to biopsy tissue from a mass in the
center of the chest (mediastinal mass.)
How is it done?
The patient is placed under general anesthesia. The neck is comfortably
extended, and the neck and chest are prepped with sterile solution.
A small one and one-half inch incision is made at the base of the
neck, just above the breast
bone. The muscles in the lower neck are separated, and the trachea
(windpipe) is located.
The surgery follows the windpipe down into the chest, where the
lymph nodes or mass are
located. A mediastinoscope, a small metal tube with a light source
inside, is introduced through
the skin incision into the center of the chest. Through this tube
the biopsies are done. When the
biopsy is complete, the mediastinoscope is removed, and the skin
and other tissues are closed
with absorbable suture material.
What are the risks?
The risk of mediastinoscopy is very low, less than one percent.
If there is a problem during surgery, it is related to bleeding
from a large blood vessel inside the chest. On a very rare
occasion, the chest may have to be opened by sternotomy or thoracotomy
to repair a bleeding
What is it?
The Chamberlain Procedure is also known as an anterior mediastinotomy.
procedure is a minimally invasive operation performed by a thoracic
surgeon. A related
procedure, known as the Jolly Procedure, is also an anterior mediastinotomy.
Chamberlain procedure is called an anterior thoracotomy.
What is it for?
The Chamberlain procedure is used to biopsy lymph nodes in the center
of the chest, or to biopsy
a mass in the center of the chest. The Chamberlain procedure differs
from a cervical
mediastinoscopy by the location of the incision, and the location
of the lymph nodes or mass to
The Chamberlain procedure is used to biopsy lymph nodes or masses
in the aorto-pulmonary
window on the left side of the chest, or nodes in the hilar areas
of the lung. (In contrast, the
cervical mediastinoscopy procedure is used to biopsy nodes or masses
to the front or side of the
trachea, or windpipe.) The aorto-pulmonary window is the area in
the center of the chest bound
by the aorta superiorly, and the pulmonary artery inferiorly. This
area contains lymph nodes that
filter lymph coming from the left lung, especially the left upper
lobe. If a lung cancer is present in
the left lung, the Chamberlain procedure is useful for staging the
cancer (determining the extent
of spread.) The hilar areas of the lung (the hilum) are the areas
of the lung where the pulmonary
artery and vein (the blood supply) join the lung.
How is it done?
The Chamberlain procedure is usually done on the left side of the
chest, because the aorto-
pulmonary window is on the left side. However, the procedure is
used for the right side under
The patient is placed under general anesthesia. The skin of the
chest is prepped with a sterile
solution. A small, two inch incision is made over the second rib
where it joins the breast bone (at
the Angle of Louis.) The incision is carried down through the pectoralis
major muscle (the "pecs")
by spreading the muscle fibers apart. The cartilage of the second
rib is located (the costal
cartilage) and is removed. The internal mammary artery and vein
deep to the cartilage are
sometimes tied and cut. The parietal pleura (the inside lining of
the chest wall) is then dissected
to the side, and the surgery is directed into the center of the
chest, between the aorta and the
pulmonary artery. Great care is taken not to injure the large blood
vessels. Biopsies are taken
of the respective abnormal lymph nodes or mass. The incision is
then closed, without replacing
Occasionally, the nodes or mass cannot be safely located or biopsied
by this technique. Under
those circumstances, a decision is made by the surgeon to enlarge
the incision slightly, open the
parietal pleura, move the lung out of the way, and approach the
nodes or mass from inside the
pleural space. By opening the pleura and extending the incision,
an anterior thoracotomy is
created. Because air has been introduced into the area around the
lung (the pleural space),
a chest tube may be required to remain overnight to drain the air
from the chest.
When the nodes or mass have been biopsied, the incision is closed
with absorbable suture, and
air is evacuated from the chest.
What are the risks?
The risk of a Chamberlain procedure is very low. The chief risk
is that of opening the pleura, and
the requirement for placement of a chest tube (drain.)
Although very rare, there is a risk of bleeding from a large blood
vessel such as the aorta or
pulmonary artery. Such bleeding would require a sternotomy or thoracotomy
to stop the bleeding
Most patients go home the same day as surgery. Most return to work
within a few days or a
week, and will require pain pills for only a few days. The patient
may shower 48 hours after
surgery, and should not soak the incision under water in a bath
tub or spa for three weeks.
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