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

  • 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

Who Performs Thoracoscopy

  • A chest surgeon or pulmonary specialist and a surgical team

Special Concerns about Thoracoscopy

  • You may undergo various preoperative tests, such as pulmonary function tests, chest x-ray, and electrocardiography, to ensure that 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 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.
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    Before the Thoracoscopy

    • Tell your doctor if you regularly take anticoagulants, nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen), or any other medications. You 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 your arm, and you are placed under general anesthesia.

    What You Experience during Thoracoscopy

    • A thin tube is inserted through your mouth and into your 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 your 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 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.

    Risks and Complications of 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).

    After the Thoracoscopy

    • You will remain in the hospital up to several days until you recover from the effects of surgery and anesthesia. During this time, your vital signs will be monitored, and you will be observed for any signs of complications.
    • You 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.

    Results of Thoracoscopy

    • Depending on the suspected problem, tissue and fluid specimens may be sent to different laboratories for inspection. For example, 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.

    Source:

    The Johns Hopkins Consumer Guide to Medical Tests

    Simeon Margolis, M.D., Ph.D., Medical Editor

    Updated by Remedy Health Media

    Publication Review By: the Editorial Staff at Healthcommunities.com

    Published: 24 Jan 2012

    Last Modified: 27 Jan 2015