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by Scholten A
(Chamberlain Procedure; Anterior Mediastinotomy)

Definition

A mediastinotomy is surgery to make a small opening in the space between the lungs (mediastinum).

The Lungs (Cut-away View)
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Reasons for Procedure

This procedure is done to examine the lungs and chest. It may be used with a biopsy to check for:

  • Cancer of the lungs , airways, and chest tissue
  • Lymphoma—cancer in the lymphatic system, such as Hodgkin disease
  • Infection
  • Sarcoidosis —a condition that affects the lungs, liver, lymph nodes, and spleen

It is also done to see if lung cancer has spread.

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:

  • Excess bleeding
  • Problems from anesthesia, such as wheezing or sore throat
  • Infection
  • Damage to other organs or structures
  • Leakage of lymphatic fluid into the chest (chylothorax)
  • Pneumothorax—air that gets trapped between the lungs and chest wall

Things that may raise the risk of problems are:

What to Expect

Prior to the Procedure

The care team may meet with you to talk about:

  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before the procedure, such as avoiding food or drink after midnight the night before
  • Whether you need a ride to and from surgery

Anesthesia

The doctor will give you general anesthesia . You will be asleep.

Description of the Procedure

A small incision will be made in the chest above the breastbone. A small tube with a light (mediastinoscope) will be inserted. It will let the doctor see the space between the lungs and chest. Tissue samples may be taken from the lungs, lymph nodes, or other parts of the chest. The tube will be removed. The incision will be closed with stitches. A bandage will be placed over the site.

Immediately After the Procedure

Right after the procedure, the staff may give you pain medicines. A chest x-ray may be taken to check for bleeding or air inside your chest space.

The tissue samples will be sent to the laboratory for testing.

How Long Will It Take?

30 minutes to 2 hours

Will It Hurt?

Pain is common in the first few days. Medicine and home care can help.

Average Hospital Stay

The usual length of stay is up to 24 hours. If you have problems, you may need to stay longer.

Post-procedure Care

At the Hospital

Right after the procedure, the staff may give you pain medicines.

During your stay, the hospital staff will take steps to lower your risk of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to lower your risk of infection, such as:

  • Washing your hands often and reminding visitors and staff to do the same
  • Reminding staff to wear gloves or masks
  • Keeping your incisions covered
At Home

It will take a few weeks for the incision to heal. Physical activity may be limited during this time. You may need to delay your return to work.

Call Your Doctor

Call your doctor if you are not getting better or you have:

  • Signs of infection, such as fever and chills
  • Redness, swelling, excess bleeding, or discharge from the incision
  • Chest pain
  • Shortness of breath
  • Swelling in the neck
  • Difficulty swallowing

If you think you have an emergency, call for medical help right away.

RESOURCES

American Cancer Society  http://www.cancer.org 

American Lung Association  http://www.lung.org 

CANADIAN RESOURCES

Canadian Cancer Society  http://www.cancer.ca 

Health Canada  https://www.canada.ca 

References

Berania I, Kazakov B, et. al. Endoscopic Mediastinal Staging in Lung Cancer Is Superior to "Gold Standard" Surgical Staging. Ann Thorac Surg. 2016 Feb;101(2):547-50.

Chamberlain procedure. Roswell Park Cancer Institute website. Available at: https://www.roswellpark.org/glossary/chamberlain-procedure Accessed January 15, 2021.

Mediastinoscopy and mediastinotomy. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/pulmonary-disorders/diagnostic-and-therapeutic-pulmonary-procedures/mediastinoscopy-and-mediastinotomy. Accessed January 15, 2021.

Sarcoidosis in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/sarcoidosis-in-adults. Accessed January 15, 2021.

Revision Information

  • Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
  • Review Date: 02/2020
  • Update Date: 01/15/2021