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Mediastinotomy

Mediastinotomy is a surgical procedure that allows the doctor to visualize the organs within the chest cavity, including the heart and its blood vessels, lymph nodes, the trachea (airway), the esophagus and thymus gland, or the central tumors. This procedure is done when a needle biopsy does not remove enough cells or tissue for further examination.

Purpose
  • To remove tissue for further examination to then formulate a treatment plan
  • To find the cause of infection or inflammation in the chest cavity
  • To confirm diagnosis of certain respiratory diseases
  1. Before the procedure you will undergo a physical examination, health screening, and laboratory tests.
  2. If you have a history of being prone to bleeding or excessive bleeding that is hard to stop or if you or a family member have bruises all over the body, please let the doctor know before the procedure.
  3. Please let your medical team know about any allergies you have to medication, food, and any other substance/chemical.
  4. You will need to fast for 8 hours before the procedure or as recommended by the doctor.
  5. You may need to stop certain medication before the procedure. Please let your doctor know about all medications and supplements you are taking so your doctor can advise if any need to be stopped before the mediastinotomy.
  6. On the day of the procedure, please bring all medication and supplements you regularly take to the hospital.
  7. You will be asked to sign consent forms before the procedure. Please read all documents before signing them.
The procedure takes approximately 60-90 minutes.
  1. You will receive fluids and medication through an intravenous (IV) line.
  2. You will receive general anesthesia by an anesthesiologist during the procedure so you will be asleep. The anesthesiologist will insert a breathing tube to help you breathe during the procedure.
  3. The surgeon will make a vertical incision measuring 4-6 centimeters in front of the ribs on the left side, at around the second to fourth ribs, depending on the area that needs to be visualized. The surgeon will use a camera in the procedure. Tissue may be removed for further examination. The doctor will then close the incision.
  1. After the procedure, your symptoms will be observed and monitored closely. You may expect to stay in the hospital for 1-2 days.
  2. You may have pain or tenderness at the incision. It is also common to experience some hoarseness or a sore throat from the breathing tube. Pain medications are usually given to relieve discomfort. Based on your results, the doctor will talk with you about treatment and further care.
  3. Nurses will support you in getting up and walking as soon as possible after the procedure to stimulate blood circulation.
The severity of complications will depend on the patient’s health, but the following complications occur in less than 1% of cases and include:
  • Bleeding from the incision
  • Infection
  • Temporary or permanent hoarseness if there is an injury or loss to the nerves controlling the vocal cords
  • Leakage of lymph into the chest cavity
  • Damage to organs within the chest cavity, perforation of the esophagus or airway, paralysis of the muscles of the diaphragm
  • Pneumothorax
 
Please let your doctor know if you develop problems, such as:
  • Fever, swelling, redness, worsening pain, bleeding, or seeping of fluid from the incision
  • Swelling of the throat
  • Difficulty swallowing
  • Hoarseness or worsening hoarseness
  • Chest pain or worsening of existing chest pain
  • Difficulty breathing

You will need to recover at home for 1-2 weeks. If you have any questions, please talk to your doctor or medical team.

·        Activity. Avoid activities that involve pulling or pushing, lifting heavy objects, and other strenuous activity as well as driving for at least 1 week as these can affect the incision. Avoid sexual intercourse until the incision is healed.

·        Wound Care. When your doctor clears you to bathe, shower daily with soap. Dry the surgical wound well and keep it clean. Don’t apply any creams, lotions, or powders to the incision until it is fully healed and appears like normal skin. Please contact your doctor if the wound is inflamed or swollen, if the pain is worsening, or if the wound is leaking fluid or blood.

·        Diet. Your diet should be restricted in accordance to existing medical conditions. Eat healthily to promote wound healing.

·        Exercise. Avoid exercising for at least 1 week.

·        Medication. If you are prescribed antibiotics, please take them until you finish them. Please take all medication as prescribed by your doctor.

·        Appointments. Please keep all follow-up appointments so your wound can be monitored and stitches removed. If you experience any abnormal symptoms, such as fever, difficulty breathing, worsening fatigue, worsening cough, coughing up abnormal sputum, etc., please see your doctor before the scheduled appointment.

  • Bronchoscopy
  • Video-assisted thoracoscopic surgery (VATS)
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET) scan

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