The trachea is accessed through a 3 cm incision 2 cm above the sternum with a mediastinoscopy. An optical mediastinoscopy instrument travels over the trachea, and the physician operates the lymph nodes and masses of the mediastinum.

This incision is closed aesthetically with sutures that are invisible and absorbable. After the operation, only a faint scar of 2-3 cm remains.

Figure 1: Location of the skin incision on the neck and placement of mediastinoscopy
Figure 2: Advancement of the instrument over the trachea
Figure 3: Biopsy map of mediastinal lymph nodes

We use mediastinoscopy for both diagnostic and staging purposes. However, it is most commonly used for the biopsy of lymph nodes, which is essential in diagnosing lung cancer.

This process determines the treatment of the patient. It helps us to decide whether the patient will receive immediate surgery, surgery after chemotherapy, or only chemotherapy and radiotherapy. It is also used for diagnostic purposes, such as tuberculosis, sarcoidosis, and other diseases involving lymph nodes, like rheumatological diseases.

Mediastinal lymph node biopsy with mediastinoscopy

Diagnostic Mediastinoscopy

  • Tuberculosis
  • Sarcoidosis
  • Lymphoma
  • Lung cancer


  • Lung cancer staging (N2 and N3)
  • Mediastinal mass biopsy

Common Misunderstanding:
While explaining this procedure to the patients, there may be misunderstandings as if there will be an incision in the trachea like a tracheostomy. However, this procedure is done below the trachea, surpassing it.