Biopsy by a cut on the front of the chest

What is anterior mediastinoscopy?

Anterior mediastinoscopy is an operation to get biopsies of a lump in the upper part of the chest (mediastinum), above the heart.

The surgery may be done to diagnose the cause of a lump in the chest which has been seen on scans. The result of the biopsies guides the best course of treatment to take.

What does the surgery involve?
You will be fully asleep under a general anaesthetic and the surgery takes about 1 hour.

A horizontal incision, about 5cm long, is made on the front of the chest either on the left or right side. A small piece of rib may be removed to give space to do the surgery. A camera and small instruments may be passed through the incision to get into the upper part of the chest. Biopsies of the lump above the heart can then be taken. The wound is closed with dissolvable stitches. You may have a small drain placed to remove any fluid or air from the operation site.

It takes up to 2 weeks for the laboratory to give results. Tests for some infections such as TB may take up to 12 weeks. If we receive results before you are due to come to a clinic appointment we may call you.

What is recovery like?
You can usually go home the same day or the next day. This depends on your recovery so bring an overnight bag just in case. If you need a chest drain after the operation and you will need to stay in hospital longer. Sometimes you may go home with a drain, a nurse will then visit you at home and you will have checks at the hospital to decide when to remove the drain.

The area around the incision and your throat will be sore but taking regular painkillers will keep you comfortable. It is normal to feel some discomfort after the surgery but if you are worried about it please tell the staff looking after you.

You will need a responsible adult to be with you for the first 24 hours after surgery. You should not drive for 48 hours and you should not go back to work before 72 hours. Drink plenty of fluids and rest when you go home.

What are the risks?
The risks discussed here are a guide; your individual risk may vary. You should discuss the risks and benefits of surgery with your consultant, especially if you are concerned.

  • Minor more common complications 

Wound infection. If your wound becomes more sore, red or leaks fluid there may be a wound infection so you should see a doctor. This is usually treated with antibiotics and dressings.

Bleeding is usually minimal. There will be some bruising and swelling on the chest.

  • Major more rare complications

Collapsed lung. The top of the lung is close to where biopsies need to be taken. Air may get into the pleural space or around the lung. This is commonly called a collapsed lung. It may be necessary to open the pleural space to take the biopsy. If you have air in the pleural space you may require a chest drain to be inserted to remove the air.

Blood clots. This is general risk with any operation that involves staying in hospital.

Injury to large blood vessels that are close to the heart. There is a small risk of major bleeding if one of these vessels is damaged. Bleeding can be controlled and the vessel repaired. To do this an additional incision would need to be made called a median sternotomy or a thoracotomy. If there is severe bleeding you may need a blood transfusion.Median sternotomy or thoracotomy incision. One of these incisions is done to get into the chest to if there is severe bleeding. A median sternotomy is a vertical incision, approximately 20cm long, in the centre of the chest which goes through the breastbone. A thoracotomy is a horizontal incision, approximately 20cm long, on one side of the chest that goes between the ribs.

Death is very rare and usually happens in a person who has a medical condition that leads to a complication.

What are the alternatives to surgery?
Having a diagnosis can guide which treatments would be best for you. It can also give you an idea of what to expect from the disease, including  symptoms or whether the condition may shorten your life.

If you do not want to have an operation other options may include:

  • Biopsies of the lump can sometimes be taken using CT guided biopsy. This is commonly tried before surgery but samples may be too small or difficult to get to.
  • Relying on existing tests (such as CT scans) to judge which disease is most likely.
  • Repeating a previous test.

It is your choice whether to go ahead with surgery. We will respect your wishes and support you in choosing the treatment that suits you best. You are always welcome to seek a second opinion.