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Mediastinotomy

(Chamberlain’s Procedure; Anterior Mediastinotomy)

Definition

The mediastinum is the area in the middle of the chest between the lungs. A mediastinotomy is the creation of a small opening in the upper chest into the mediastinum. This opening allows the doctor to examine the area between and in front of the lungs.
The Lungs (Cut-away View)
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Reasons for Procedure

This procedure is done to examine the lungs and chest. Your doctor might take tissue samples (biopsy). These samples are examined under a microscope to check for diseases like:
  • Cancer of the lungs, bronchi, and chest tissue
  • Lymphoma—cancer in the lymphatic system, such as Hodgkin’s disease
  • Infection
  • Inflammation
  • Sarcoidosis—a condition that causes inflammation in organs like the lungs, liver, lymph nodes, and spleen
Mediastinotomy is also done to find out if lung cancer has spread.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Bleeding
  • Infection
  • Hoarseness
  • Chylothorax—leakage of lymphatic fluid into the chest
  • Damage to organs in the chest
  • Collapsed lung—pneumothorax
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

What to Expect

Prior to the Procedure

You will be asked to stop eating and drinking for 8-10 hours before the procedure.
You may be asked to stop taking some medications up to one week before the procedure.
On the day of the procedure:
  • You will be asked to remove any jewelry, glasses, contact lenses, or dentures.
  • You may be given medications to help you feel sleepy and relaxed.
  • Be sure to tell your doctor if you have any allergies.
  • You will need someone to drive you home after the procedure.

Anesthesia

General anesthesia—you will be asleep during the procedure

Description of the Procedure

The doctor will make a small cut in the chest. Muscles will be moved aside in order to examine the space between the lungs and heart. Samples may be taken from the lungs, lymph nodes, or other chest tissue. The doctor will close the incision with stitches. The wound will be covered with a dressing or bandage.

Immediately After the Procedure

You will be taken to the recovery room for monitoring.

How Long Will It Take?

30 minutes to 2 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

This procedure can be done in an outpatient setting or as part of your hospital stay. The usual length of stay is up to 24 hours, if there are no unforeseen complications. Some people may need to stay in the hospital for 1-2 days.

Post-procedure Care

At the Hospital
  • In the recovery room, the care staff will monitor your breathing, pulse, and heart rate.
  • Your doctor may order a chest x-ray to check for bleeding or air inside your chest space.
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
You will have restrictions on specific activities during your recovery. Follow instructions on wound care to prevent infection. Your doctor may advise pain medications to ease discomfort.

Call Your Doctor

It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:
  • Redness, swelling, pain, or bleeding from the wound
  • Chest pain
  • Swelling in the neck
  • Difficulty swallowing
  • Hoarseness that lasts more than a few days or worsens
  • Shortness of breath
  • Signs of infection, including fever and chills
  • Joint pain, fatigue, stiffness, rash, or other new symptoms
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
http://www.hc-sc.gc.ca

References

Chamberlain procedure. Roswell Park Cancer Institute website. Available at: https://www.roswellpark.org/glossary/chamberlain-procedure Accessed February 2, 2015.
Mediastinoscopy and mediastinotomy. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/pulmonary%5Fdisorders/diagnostic%5Fpulmonary%5Fprocedures/mediastinoscopy%5Fand%5Fmediastinotomy.html. Updated September 2013. Accessed February 2, 2015.
Sarcoidosis in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 1, 2014. Accessed February 2, 2015.
6/6/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.

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