Mediastinoscopy with biopsy of lymph nodes
PREOPERATIVE DIAGNOSIS: Mediastinal mass.
POSTOPERATIVE DIAGNOSIS: Mediastinal mass. Final pathology report pending.
OPERATIVE PROCEDURE: Mediastinoscopy and mediastinal node biopsies.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room, placed in the supine position with the neck extended and prepped and draped in a routine manner. A small transverse incision was made just above the sternal notch. Dissection was carried down through the midline to the trachea. One large vein was ligated. My index finger was inserted down to the level of the trachea and then advanced gently into the anterior mediastinum. The mediastinoscope was then introduced.
Representative samples of fat and apparent nodes were obtained in the right paratracheal gutter. Additional tissue was obtained from the hilum and to the edge toward the left side of the trachea. All the tissue appeared to be similar, with what was thought to be multiple small nodes with perhaps a light pearl color to them, and no hard, definitive mass worrisome for malignancy was identified.
Rapid frozen section of the early representative samples indicates quality diagnostic tissue was obtained without evidence of obvious malignancy. Pathology prefers to defer final diagnosis regarding possible lymphoproliferative process until the permanent sections are obtained. Additional samples were obtained, including several larger pieces that appeared to be very representative.
The wound appeared to be hemostatic. The scope was withdrawn. The wound was closed in layers using 3-0 Polysorb for the deep tissue and 4-0 Caprosyn for skin. Sterile dressings were applied. The patient was then awakened and returned to the recovery room.
ESTIMATED BLOOD LOSS: Minimal.
POSTOPERATIVE CONDITION: Satisfactory.