Mediastinoscopy is introduction of an endoscope into the mediastinum. Mediastinotomy is surgical opening of the mediastinum. The two are complementary procedures; mediastinotomy gives direct access to aortopulmonary window lymph nodes, which are inaccessible to mediastinoscopy. Both procedures are performed to evaluate or excise mediastinal lymphadenopathy or masses and to stage cancers (eg, lung and esophageal cancer), though PET scan is decreasing the need for the procedures in the latter indication.

Contraindications include superior vena cava syndrome; previous mediastinal irradiation, mediastinoscopy, median sternotomy, or tracheostomy; and aneurysm of the aortic arch.

Mediastinoscopy and mediastinotomy are performed by surgeons in an operating room using general anesthesia. For mediastinoscopy, neck soft tissue is bluntly dissected down to the trachea and distally to the carina through an incision in the suprasternal notch. A mediastinoscope is inserted into the space, allowing access to paratracheal, tracheobronchial, azygos, and subcarinal nodes and to the superior posterior mediastinum. Anterior mediastinotomy (Chamberlain procedure) is surgical entry to the mediastinum through a parasternal 2nd left intercostal space incision, allowing access to anterior mediastinal and aortopulmonary window lymph nodes, common sites of metastases for left upper lobe lung cancers.

Complications occur in < 1% of patients and include bleeding, infection, vocal cord paralysis from recurrent laryngeal nerve damage, chylothorax from duct injury, and pneumothorax.