Thoracoscopy: What it is, Purpose, Risks, Complications, Results and Special Concerns

Definition:

It is a minimally invasive surgical process to access the thoracic cavity to perform therapeutic or diagnostic procedures.

A thin, flexible vision tube (called a thoracoscope) is inserted through a small incision in the chest in thoracoscopy.

The fiber optic cables allow the surgeon to visually inspect the lungs, the mediastinum (the area between the lungs), and the pleura (the membrane covering the lungs and lines the chest cavity).

In addition, surgical instruments can be inserted through other small incisions in the chest to perform diagnostic and therapeutic procedures.

Purposes of thoracoscopy

  • To visually inspect the lungs, pleura, or mediastinum for abnormalities.
  • To obtain tissue biopsies or fluid samples from the lungs, pleura, or mediastinum to diagnose infections, cancer, and other diseases.
  • It is used therapeutically to remove excess fluid in the pleural cavity or pleural cysts or remove a portion of diseased lung tissue.
  • Evaluate patients with lung disease or abnormalities of the sac surrounding the heart (pericardium) or the chest lining.
  • To obtain a tissue sample (biopsy) for further evaluation and diagnosis of inflammation, infection, fibrosis, and cancer.
  • As a minimally invasive method to perform certain types of surgery, such as pericardiectomy

Who performs thoracoscopy?

A chest surgeon or pulmonary specialist and a surgical team.

Particular concerns about this procedure

You can have several preoperative tests, such as pulmonary function tests, chest x-rays, and electrocardiography, to ensure you are 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 can not breathe with just one lung (since a lung must be partially or wholly 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 if the procedure can not be completed satisfactorily, an open thoracotomy may be required.

Before

Before having a thoracoscopy, inform your doctor if you regularly take blood thinners, non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen) or any other medicine.

You may be asked to stop certain medications before the test. Also, mention any herbs or supplements you take.

Immediately before the test, a needle or intravenous (IV) catheter is inserted into a vein in the arm and placed under general anesthesia. Therefore, do not eat or drink anything for 12 hours before the test.

During

A thin tube is inserted through the mouth and into the lungs during thoracoscopy. The lung on the operative side is wholly or partially deflated to create space between the lung and the chest wall and provide the surgeon with a clear view of the area.

The surgeon makes several small incisions in the chest and inserts drainage tubes to draw blood during the procedure. The endoscope passes into the space between the lung and the chest wall; The fiber optic cables transmit images of the area to a TV screen in the operating room. The scope can be moved to different locations as needed.

After the lung and pleura inspection, the doctor can insert surgical instruments through small incisions to remove tissue or fluid for diagnostic examination or as a therapeutic measure.

The endoscope and other instruments are removed, the collapsed lung is expanded again, and all incisions, except 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 to drain the air and fluid from the chest.

The procedure takes between 45 and 90 minutes.

Risks and complications

Rare complications include:

  • Excessive bleeding.
  • Infection.
  • Perforation of the diaphragm.
  • Pneumothorax (leakage of air out of the lungs and into the pleural cavity, resulting in a lung collapse).

Thoracoscopy requires general anesthesia and, therefore, carries the associated risks.

After

After the thoracoscopy, you will stay in the hospital for several days until you recover from surgery and anesthesia. During this time, your vital signs will be monitored, and you will be observed for signs of complications.

Pain relievers may be given to relieve the discomfort associated with the surgery. A chest x-ray will be done to ensure complete reinflation of the lung.

Results of thoracoscopy

Depending on the suspected problem, tissue and fluid samples can be sent to different laboratories for inspection. For example, the biopsied tissue can be inspected under a microscope for signs of unusual cells, or it can be cultured for infectious organisms.

If a malignant lung tumor is suspected, the biopsy specimens can be examined through the frozen section during the procedure. Additional surgical procedures may be performed immediately to remove all or part of the affected lung if lung cancer is detected.

If a definitive diagnosis can be made, appropriate treatment will be initiated. If the doctor can not make a diagnosis, additional tests may be needed, such as bronchoscopy or an open lung biopsy.