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Before your mediastinoscopy

Be sure your doctor knows about any medicines you are taking, including vitamins, herbs, and supplements, as well as if you have allergies to any medicines.

You might be asked to stop taking blood-thinning medicines, including aspirin, for several days before the test to reduce your risk of bleeding. Your doctor may also ask you to adjust or stop other medicines as well, such as those for diabetes. If you normally take prescription medicines in the morning, talk with your doctor or nurse about how to manage them on the day of your test.

You will likely be asked not to eat or drink anything for at least several hours before the procedure. Your doctor or nurse will give you specific instructions. Be sure to follow them and to ask questions if there’s anything you don’t understand.

Making a transportation plan

Because anesthesia is used to help keep you more comfortable during the procedure, you will need to arrange for a ride home after the test.

You might be sleepy or dizzy and need someone to help you get safely into your home, so a cab or rideshare service may not be a good option. Some centers will not allow you to use a cab or rideshare after this procedure.

If transportation or help getting home might be a problem, talk with your health care provider. There may be other resources available, depending on the situation.

During your mediastinoscopy

Mediastinoscopy can usually be done as an outpatient procedure, where you don’t need to stay overnight in a hospital. Your doctor will review the procedure with you and ask you to sign a consent form.

For this test, you’ll change into a hospital gown and lie on your back on a table. Your blood pressure, heart rate, and breathing will be monitored. You will be given general anesthesia through an intravenous (IV) line to put you in a deep sleep.

A breathing tube will be placed through your mouth or nose, into your trachea, and connected to a machine.

A small cut will be made just above your breastbone and the mediastinoscope will be slowly moved into the mediastinum. If abnormal lymph nodes or areas are seen, the doctor will remove or biopsy them with the cutting tool and send them to be checked in the lab.

The mediastinoscope will be removed, the cuts closed, and then the breathing tube will then be removed.

The procedure usually takes about 60 minutes, but it might take longer depending on what’s being done.

After your mediastinoscopy

After the procedure, you will be watched closely for any problems. As the anesthesia wears off, you may be groggy or confused for a few hours.

If you had the procedure as an outpatient, you should be able to go home after a few hours. Someone will need to drive you home and stay with you until the anesthesia wears off.  Your doctor or nurse should give you specific instructions to follow after the test, including when to start taking medicines again that may have been stopped for the procedure.

Your mouth and throat will likely be numb afterwards, so you won't be allowed to eat or drink right away. Once the numbness wears off, you may have a sore throat, cough, or hoarseness for the next day or so. You may have pain or numbness in the sites where the cuts were made.

If biopsies were taken, results are usually ready within a few days, although some might take longer. You will need to follow up with your doctor after the procedure to get your results.

Possible risks of a mediastinoscopy

Mediastinoscopy is usually safe, but there is a small risk of certain complications.

Bleeding: If a biopsy was done, a small amount of bleeding could happen where the doctor removed tissue samples.

Pneumothorax (collapse of part of a lung): This is rare but can happen after a biopsy or from pressure in the airways during the procedure.

Injury to the mediastinal tissues, nerves, and organs: Sometimes, damage to the surrounding tissues and organs can happen during the procedure. Depending on the site of damage, this can result in hoarseness, difficulty swallowing, pain, bleeding, or buildup of air or fluid in the space between the lungs.

Infection: In rare cases, the cuts can get infected or you could get a lung infection (pneumonia).

Drug reactions: Sometimes the anesthesia can cause changes in blood pressure, confusion, dizziness, or even an allergic reaction. You will be watched closely for any medicine side effects and they will be treated, if needed.

Your doctor may order a chest x-ray after the mediastinoscopy to check for pneumothorax or other lung problems. Some problems might go away on their own, but if they’re causing symptoms, such as trouble breathing, they might need to be treated.

Before you go home, your doctor or nurse should give you specific instructions on when you might need to call the doctor’s office for problems. In general, these include:

• Coughing up small amounts of blood
• Cough that is persistent
• Fever that doesn’t go away
• Vomiting
• Hoarseness
• Trouble swallowing
• Wheezing that is unusual for you

Call 911 or go to the emergency room if you have:

• Severe, sudden pain in the neck
• Severe pain when swallowing
• Chest pain or pressure that is increasing
• Trouble breathing (new)
• Coughing up large amounts of blood

Be sure you understand what you should watch out for, the possible timing of when problems might occur, and when you should call for problems.