The development of Cervical Mediastinoscopy by Carlens (1959) enabled to explore the lymph nodes in the superior mediastinum and by incorporating advanced techniques such as Extended Mediastinoscopy and Pleuromediastinoscopy; the Anterior Mediastinum too has been accessed. Thus a direct prethoracotomy evaluation of the existence and extent of metastatic disease within the mediastinum can be assessed. It established a practical method for determining the TNM classification and is an appropriate procedure essentially for all patients before planned resection especially in pneumonectomy.
Nodes accessible are stations two, three, and four (paratracheal), station five (aortopulmonary), station six (anterior mediastinum), station seven (subcarinal) and sometimes station ten (tracheobronchial angle).
Gdeedo and colleagues (1997) demonstrated in one hundred consecutive patients with non-small cell lung carcinoma without distant metastases who underwent staging by CT and mediastinoscopy that the overall sensitivity and specificity of CT were 63 and 57% respectively, and of mediastinoscopy 89 and 100% respectively.
The procedure is performed under general anaesthesia and the development of a pre-tracheal tunnel through a small single cervical incision combined with a specifically designed lighted speculum, the mediastinoscope.
 |
 |
| Lower cervical incision |
Lower cervical incision |
In trained hands, the incidence of complications (bleeding, vocal cord paralysis and pneumothorax) is 0.2% .
Mediastinoscopy - 2000 to 2006 (NY)
| Tuberculosis |
29 |
| Malignancy |
12 |
| Lymphoma |
9 |
| Sarcoidosis |
4 |
| Non–specific |
5 |
| Total |
59 |
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