Cervical mediastinoscopy is a valuable surgical technique used for the diagnosis of mediastinal disease and the staging of lung cancer. Although complications of cervical mediastinoscopy are uncommon, the most common major complication is

A. airway disruption.
B. esophageal perforation.
C. hemorrhage.
D. recurrent nerve palsy.
E. stroke.

Answer C

Cervical mediastinoscopy as originally described by Carlens and promoted by Pearson is a proven valuable technique for the diagnosis of mediastinal disease and staging of lung cancer. Retrospective and prospective series have documented the efficacy and safety of this technique. Major complications occur in <3% and should be minimized by proper technique and careful dissection.

The trachea and mainstem bronchi are susceptible to disruption by blunt or sharp trauma but injuries to these structures are usually self limiting. Esophageal disruption occurs rarely because of the posterior mediastinal location of this organ. Major hemorrhage can occur from injury to the azygos vein or pulmonary artery. Initial control can usually be secured by tamponade, but operative intervention for direct ligation or repair is most commonly required. A pneumothorax can occur if the mediastinal pleura is breached. This complication can usually be easily controlled by a small tube thoracostomy drain connected to an underwater seal through the cervical incision at the time of closure or by percutaneous aspiration immediately postoperatively. The left recurrent nerve lies in the left tracheobronchial angle and along the left paratracheal space and it can be directly traumatized at the time of mediastinoscopy. This occurs in <0.5% of cases and rarely does the ensuant vocal cord palsy require vocal cord augmentation or laryngoplasty.