Answer:

For many years, cervical mediastinoscopy was the gold standard for evaluating disease in the mediastinum and the staging of lung cancer. However, with the introduction of EBUS, cervical mediastinoscopy has become less common. Independent of the technique used, if lymph nodes are positive for malignancy by frozen section, the patient is probably not a candidate for surgical resection at the time of biopsy.

Conventional cervical mediastinoscopy involves a small incision at the sternal notch for the insertion of the mediastinoscope and sampling of lymph nodes. The pleural space is generally not entered intentionally, and, therefore, a chest tube is not indicated. Occult pneumothorax can occur as a complication, so a chest radiograph is usually obtained before discharge. Complications during mediastinoscopy are relatively rare (1% to 2%) and generally result from trauma to adjacent structures (pleura, trachea, esophagus, superior vena cava, azygos vein, innominate artery, pulmonary artery, and aorta) or nerve injury (recurrent laryngeal or phrenic nerve). Should a major vascular structure be perforated, blood loss can be rapid and profound, necessitating emergent sternotomy. Because packing or vascular clamps may be applied to the superior vena cava, clinicians should always have a plan for establishing venous access in the lower extremity.

• Kaplan JA, Slinger PD, eds. Thoracic Anesthesia. 3rd ed. Philadelphia, PA: Churchill Livingstone; 2011:155-168.
• Wells FC, Coonar AS, eds. Thoracic Surgical Techniques. New York: Springer; 2018:191-194.