A mediastinoscopy is a surgical procedure during which a small incision is made at the base of the neck, just above the breastbone (sternum). Your surgeon inserts a mediastinoscope (a tube containing a camera) into this incision to examine the many lymph nodes in the center of the chest (mediastinum). The lymph nodes are biopsied and sent to the pathology laboratory to determine if there is cancer in the node(s). This procedure is done in the operating room under general anesthesia. If you have a mediastinoscopy, you may be able to go home the same day. The final pathology report, however, will take up to 3-5 working days and will be reviewed with you when you return for a postoperative visit.
How to Prepare for Your Procedure
Many medications, whether over-the-counter or prescription, can interfere with normal blood clotting and increase the risk of bleeding. Follow the guidelines in the chart below. If your doctor gives you different instructions, always follow your doctor’s instructions.
7 days before your procedure, STOP:
- herbal & garlic supplements
- Plavix® (clopidogrel)
5 days before your procedure, STOP:
- Coumadin® (warfarin)
3 days before your procedure, STOP:
All nonsteroidal antiinflammatory medications (NSAIDs):
- Advil® or Motrin® (ibuprofen)
- Aleve® or Anaprox® (naproxen)
- Feldene® (piroxicam)
- Clinoril® (sulindac)
- Orudis® (ketoprofen)
2 days (48 hrs) before your procedure, STOP:
- Fragmin® (dalteparin)
- Arixtra® (fondaparinux)
1 day (24 hrs) before your procedure, STOP:
- Lovenox® (enoxaparin)
- DO NOT eat or drink after midnight the night before the surgery; this includes gum, candy, lollipops, water, coffee, juice, etc.
What to Expect on the Day of Your Procedure
- On the day of your surgery, take only the medications approved by your anesthesiologist. You may take them with a tiny sip of water. If you are not sure which medications to take, please contact the Thoracic Center.
- If you have diabetes you should not take your morning medicine since you will not be eating until after the procedure.
- When you arrive the morning of your surgery you will check in at the Patient Access Department (Registration), located on the ground floor in the hospital lobby. You will then be directed to 3 West or a similar area.
- An intravenous catheter (IV) will be placed in a vein in your arm so that medications can be given to you for the surgery.
- You will be taken to a “holding area”, which is located just outside the operating room. The anesthesiologist will meet you there before you are taken into the operating room. Your family will not be able to join you in the holding area.
What You Can Expect After Your Procedure
- Following the procedure, you will be observed closely in the Recovery Room (Post-Anesthesia Care Unit-PACU) for about 1 hour. You will be returned to the unit where you started until your doctor discharges you. If you are admitted to a surgical floor, you will probably be discharged in the morning.
- You can eat and drink once you are fully awake and the anesthesia has worn off (after your gag reflex has returned to normal).
- You may have pain and some swelling at the incision site for 1- 2 weeks. You will be given a prescription for pain medications to be taken as needed.
- Pain medicine can be constipating and you may need to take a stool softener while taking them. Let your doctor know if this is a problem.
- You will go home with a small dressing or a clear plastic covering over the incision. Sutures are internal and will dissolve. If you have tape closures (steri-strips), they will fall off within 2 weeks as the incision heals. You may remove the tape yourself after 7 days if it is causing itching or discomfort.
- You will need to keep the incision site clean and dry for 48 hours and then you may shower.
- You may have blood-tinged mucous for 3 to 4 days after the procedure. If you cough up a large amount of blood, however, call your doctor.
- You may experience hoarseness or a sore throat but it should go away after a few days.
When to Call Your Doctor
Please call your doctor immediately if you experience any of the following:
- Redness at the incision site
- Drainage of blood or pus from the incision site
- Temperature of 100.5°F (38°C) degrees or higher
- Progressive swelling at the incision site (some swelling is normal)
- Persistent hoarseness or a persistent change in your voice.
Questions or Concerns
If you have any problems or questions about your procedure, please call the Thoracic Center at 716 845-3167. Nights, weekends, and holidays, please call 716 845-2300 and ask for the thoracic surgeon on call.