Mediastinoscopy

Mediastinoscopy
Intervention
ICD-9-CM	34.22
MeSH	D008481
OPS-301 code	1-691.1

Mediastinoscopy is a procedure that enables visualization of the contents of the mediastinum, usually for the purpose of obtaining a biopsy.^[1] Mediastinoscopy is often used for staging of lymph nodes of lung cancer or for diagnosing other conditions affecting structures in the mediastinum such as sarcoidosis or lymphoma.

Mediastinoscopy involves making an incision approximately 1 cm above the suprasternal notch of the sternum, or breast bone. Dissection is carried out down to the pretracheal space and down to the carina. A scope (mediastinoscope) is then advanced into the created tunnel which provides a view of the mediastinum. The scope may provide direct visualization or may be attached to a video monitor.

Mediastinoscopy provides access to mediastinal lymph node levels 2, 4, and 7.

Current Use

Historically, mediastinoscopy has been the gold standard for the staging of lung cancer. However, with advances in minimally invasive procedures and imaging, mediastinoscopy usage has declined significantly.^[2]

Extended mediastinoscopy

Extended mediastinoscopy is a technique which allows access to the pre-aortic (station 6) and aortopulmonary window (station 5) lymph nodes.

Parasternal mediastinotomy

Parasternal mediastinotomy, aka, a Chamberlain procedure, is the standard approach to access lymph nodes at stations 5 and 6.

References

↑ Kaiser LR (2008). Fishman's Pulmonary Diseases and Disorders (4th ed.). McGraw-Hill. pp. 1853–1854. ISBN 0-07-145739-9.
↑ Vyas, Krishna S.; Davenport, Daniel L.; Ferraris, Victor A.; Saha, Sibu P. (2013). "Mediastinoscopy". Southern Medical Journal 106 (10): 539–44. doi:10.1097/SMJ.0000000000000000. PMC 4387790. PMID 24096946.

Tests, surgery and other procedures involving the respiratory system (ICD-9-CM V3 21–22, 30–34, ICD-10-PCS 0B)

Upper RT	nose Rhinoplasty Septoplasty Rhinectomy Rhinomanometry sinus Sinusotomy larynx Laryngoscopy Laryngectomy Laryngotomy Thyrotomy

Lower RT	trachea Cricothyrotomy Tracheoesophageal puncture Tracheotomy bronchus Bronchoscopy lung Pneumonectomy Lobectomy Wedge resection Lung transplantation Decortication of lung Heart-lung transplant

Chest wall, pleura, mediastinum, and diaphragm	pleura/pleural cavity Thoracentesis Pleurodesis Thoracoscopy Thoracotomy Chest tube mediastinum Mediastinoscopy Nuss procedure

Medical imaging	Bronchography CT pulmonary angiogram High resolution CT Spiral CT Ventilation/perfusion scan

CPRs	Pneumonia severity index CURB-65

Lung function test	Body plethysmography Spirometry Bronchial challenge test Capnography Diffusion capacity

Cytology	Sputum culture Bronchoalveolar lavage

Respiratory therapy/ intubation	Mechanical ventilation Positive pressure ventilation Artificial respiration Nebulizer Hyperbaric medicine Oxygen therapy Decompression chamber Heliox Negative pressure ventilator Postural drainage CPR

Endoscopy

Gastrointestinal tract	Upper: Esophagogastroduodenoscopy Lower: Enteroscopy Colonoscopy Sigmoidoscopy Proctoscopy Anoscopy Capsule endoscopy Accessory: Endoscopic retrograde cholangiopancreatography

Respiratory tract	Rhinoscopy Laryngoscopy Bronchoscopy

Urinary tract	Nephroscopy Ureteroscopy Cystoscopy

Female reproductive system	Colposcopy Hysteroscopy Falloposcopy Culdoscopy

Closed cavity via incision	Laparoscopy Laparoscopic surgery Arthroscopy Thoracoscopy Mediastinoscopy Coelioscopy

Other	Fetoscopy Angioscopy Otoscopy

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