Mediastinotomy and surgery of mediastinal tumors

Mediastinotomy

Mediastinotomy is the creation of a small hole in the upper chest in the mediastinum. This hole allows the doctor to examine the area between the lungs. This area is called mediastinum, it includes the heart, large blood vessels, trachea and bronchi, lymph nodes and lymph vessels, and the thymus gland. The mediastinum is divided into anterior, middle and posterior.

Mediastinotomy is performed by our leading doctors in the conditions of high medical standards at one of the leading Israeli hospitals.

⇒ Best cardiologists of Israel 2022 – Forbes

Mediastinotomy is performed to examine the lungs and chest. During mediastinotomy, a biopsy can be performed – a tissue sample of one of the mediastinal organs, in order to diagnose or exclude one of such diseases as:

• Hodgkin lymphoma
  Lung cancer, bronchi and chest tissue cancer
  Sarcoidosis – inflammation in lungs, liver, lymph nodes and spleen
  Infections
• Mediastinotomy is also performed when it is necessary to determine whether lung cancer has spread to the mediastinal organs.

You will be asked to stop eating and drinking 8-10 hours before the procedure, as well as tp stop taking some medicines a week before the procedure. Mediastinotomy is performed under general anesthesia for 30 minutes to 2 hours. The usual duration of stay in the hospital after the procedure is up to 24 hours, if there are no complications. Some patients are advised to stay in the clinic for 1-2 days.

Mediastinal Biopsy

A mediastinal biopsy is performed for:

• Lung cancer severity assessments to determine treatment strategies.
  Diagnostics of pathogens mediated by the mediastinal lymph nodes: infectious diseases such as tuberculosis, autoimmune diseases such as sarcoidosis, and tumors (lymphoma, carcinoma).

It should be noted that in many cases a biopsy is performed not by surgery, but by endobronchial ultrasound (through the introduction of EBUS into the trachea) or esophagus (EUS-endoscopic ultrasound).

The surgery is performed by one of three methods:

1. Thoracoscopy with video – a thoracoscope is inserted through several small punctures in the chest wall.

2. Auxiliary mediastinoscopy with video – an incision is made at the base of the neck over the sternum.

3. Mediastinostomy – this method is usually not used. The incision is adjacent to the sternum.

Lumpectomy – Mediastinal Excision

Large tumors in the mediastinum, especially in its anterior or upper parts, are a serious problem for anesthetists. These tumors can compress the airways or large blood vessels of the heart. This narrowing is enhanced during general anesthesia due to decreased muscle tone, changes in the airways and lung mechanics, and can lead to cardiospiratory degeneration and collapse of the airways to the point of apnea. These effects are more pronounced in children, and therefore, indications for such a surgery should be considered by a very experienced surgeon and anesthetist to avoid general anesthesia in a properly equipped hospital.

Tumors of the mediastinum:

• ♦ Timoma
  ♦ Teratoma
  ♦ Lymphoma
  ♦ Cystic hygroma
  ♦ Bronchogenic cyst
  ♦ Thyroid carcinoma

Mid sternotomy

Mid sternotomy is a puncture of the middle part of the chest (mid-thoracic puncture) or thoracotomy on one side of the chest. In this case, our doctors make every effort to avoid general anesthesia when the tumor is large and it presses on the large trachea or blood vessels. If possible, our doctors perform a biopsy under local anesthesia, and sometimes a large tumor can be reduced by chemotherapy or radiation therapy.

Thymus surgery

The thymus is located in front of the chest behind the sternum. This gland is associated with the process of maturation of T-lymphocytes, which are a component of the immune system. Mostly iron degenerates during adolescence.

Thymus or Thymus Tumor – Thymoma
Patients diagnosed with myasthenia gravis, even in the absence of thymoma, may be shown to have a thymectomy (removal of the thymus gland), as some of these patients have a chance of thymoma occurring throughout life. Thymectomy can lead to a significant improvement in the course of the disease.

If there is no thymoma, a sternotomy procedure (mid-thoracic incision) is performed, sometimes only in the upper part of the bone or right-sided surgery (thoracoscopy with video) is a minimally invasive procedure in which a camera and thin surgical instruments are inserted into several punctures in the chest. This method is used when the tumor is small and limited. All the thymus and fat around it are removed, but the resection is not as aggressive as in the case of thymoma.

In the case of thymoma, a complete sternotomy is performed (incision in the middle of the stern along the entire length). Aggressive resection of the thymus gland, sometimes with a phrenic nerve, harmless venous ligation, resection of the pericardium or pleura (pulmonary membrane) and, if there is a pulmonary infiltration, partial resection of the lung is performed.