In thoracoscopy, a thin, flexible viewing tube (called a thoracoscope) is inserted through a small incision in the chest.
Fiberoptic cables permit the surgeon to visually inspect the lungs, mediastinum (the area between the lungs), and pleura (the membrane covering the lungs and lining the chest cavity).
In addition, surgical instruments may be inserted through other small incisions in the chest, to perform both diagnostic and therapeutic procedures.
Purpose of the Thoracoscopy
Who Performs Thoracoscopy
- To visually inspect the lungs, pleura, or mediastinum for evidence of abnormalities
- To obtain tissue biopsies or fluid samples from the lungs, pleura, or mediastinum in order to diagnose infections, cancer, and other diseases
- Used therapeutically to remove excess fluid in the pleural cavity or pleural cysts, or to remove a portion of diseased lung tissue (wedge resection).
- To evaluate patients with pulmonary disease or abnormalities of the sac that surround the heart (pericardium) or the lining of the chest (pleura)
- To obtain a tissue sample (biopsy) for further evaluation and to diagnose inflammation, infection, fibrosis and cancer
- As a minimally-invasive method to perform certain types of surgery, such as pericardiectomy
A chest surgeon or pulmonary specialist and a surgical team
Special Concerns about Thoracoscopy
Before the Thoracoscopy
- The patient may undergo various preoperative tests, such as pulmonary function tests, chest x-ray, and electrocardiography, to ensure that the patient is an appropriate candidate for this procedure.
- Thoracoscopy may not be safe for people who have had previous lung surgery, who have severe bleeding disorders, or who cannot breathe with just one lung (since one lung must be partially or completely deflated during the procedure).
- This procedure is associated with fewer risks, less postoperative pain, and faster recovery than open chest surgery (thoracotomy) however, if bleeding or other complications occur, or the procedure cannot be completed satisfactorily, an open thoracotomy may be required.
What the patient Experience during Thoracoscopy
- Tell the doctor if the patient regularly takes anticoagulants, non-steroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen), or any other medications. The patient may be instructed to discontinue certain drugs before the test. Also, mention any herbs or supplements that you take.
- Do not eat or drink anything for 12 hours before the test.
- Immediately before the test, an intravenous (IV) needle or catheter is inserted into a vein in the patient’s arm, and he is placed under general anesthesia.
Risks & Complications of Thoracoscopy
- A thin tube is inserted through the patient’s mouth and into his lungs. The lung on the operative side is partially or completely deflated to create space between the lung and chest wall and provide the surgeon with a clear view of the area.
- The surgeon makes several small incisions in the patient’s chest and inserts drainage tubes to remove blood during the procedure. The scope is passed into the space between the lung and chest wall fiberoptic cables transmit images of the area onto a TV screen in the operating room. The scope may be moved to different locations as needed.
- Following the inspection of the lung and pleura, the doctor may insert surgical instruments through small incisions to remove tissue or fluid for diagnostic examination or as a therapeutic measure.
- The scope and other instruments are removed, the collapsed lung is re-expanded, and all the incisions but one are closed with stitches or adhesive tape. A thin tube is placed in the remaining incision and left there for 1 to 2 days, in order to drain air and fluid from the chest.
- The procedure takes between 45 and 90 minutes.
After the Thoracoscopy
- Thoracoscopy requires general anesthesia, and thus carries the associated risks.
- Rare complications include excessive bleeding, infection, perforation of the diaphragm, and pneumothorax (leakage of air outside the lungs and into the pleural cavity, resulting in a collapsed lung).
Results of Thoracoscopy
- The patient will remain in the hospital up to several days until he recovers from the effects of surgery and anesthesia. During this time, the patient’s vital signs will be monitored, and he will be observed for any signs of complications.
- The patient may be given pain-relieving medication to allay the discomfort associated with surgery.
- A chest x-ray will be performed to ensure complete reinflation of the lung.
- Depending on the suspected problem, tissue and fluid specimens may be sent to different laboratories for inspection. For example, the biopsied tissue may be inspected under a microscope for signs of unusual cells or may be cultured for infectious organisms.
- If a malignant lung tumor is suspected, biopsy specimens may be examined during the procedure via frozen section. If lung cancer is detected, additional surgical procedures may be performed immediately to remove all or part of the affected lung.
- If a definitive diagnosis can be made, appropriate treatment will be initiated.
- If the doctor cannot make a diagnosis, additional tests, such as a bronchoscopy or open lung biopsy, may be needed.