Definition :
Thoracoscopy is the insertion of an endoscope, a narrow-diameter tube with a viewing mirror or camera attachment, through a very small incision (cut) in the chest wall.
Description :
Thoracoscopy is most commonly performed in a hospital, and general anesthesia is used. Some of the procedures are moving toward outpatient services and local anesthesia. More specific names are sometimes applied to the procedure, depending on what the target site of the effort is. For example, if a physician intends to examine the lungs, the procedure is often called pleuroscopy. The procedure takes two to four hours.
The surgeon makes two or three small incisions in the chest wall, often between the ribs. By making the incisions between the ribs, the surgeon minimizes damage to muscle and nerves and the ribs themselves. A tube is inserted in the trachea and connected to a ventilator, which is a mechanical device that assists the patient with inhaling and exhaling.
The most common reason for a thoracoscopy is to examine a lung that has a tumor or a metastatic growth of cancer. The lung to be examined is deflated to create a space between the chest wall and the lung. The patient breathes with the other lung with the assistance of the ventilator.
A specialized endoscope, or narrow-diameter tube, with a video camera or mirrored attachment, is inserted through the chest wall. Instruments for taking necessary tissue samples are inserted through other small incisions. After tissue samples are taken, the lung is reinflated. All incisions except one are closed. The remaining open incision is used to insert a drainage tube. The tissue samples are sent to a laboratory for evaluation.
Definition :
Thoracoscopy is the insertion of an endoscope, a narrow diameter tube with a viewing mirror or camera attachment, through a very small incision (cut) in the chest wall.
Purpose :
Thoracoscopy makes it possible for a physician to examine the lungs or other structures in the chest cavity, without making a large incision. It is an alternative to thoracotomy (opening the chest cavity with a large incision). Many surgical procedures, especially taking tissue samples (biopsies), can also be accomplished with thoracoscopy. The procedure is done to:
assess lung cancer
take a biopsy for study
determine the cause of fluid in the chest cavity
introduce medications or other treatments directly into the lungs
treat accumulated fluid, pus (empyema), or blood in the space around the lungs
For many patients, thoracoscopy replaces thoracotomy. It avoids many of the complications of open chest surgery and reduces pain, hospital stay, and recovery time.
Precautions :
Because one lung is partially deflated during thoracoscopy, the procedure cannot be done on patients whose lung function is so poor that they do not receive enough oxygen with only one lung. Patients who have had previous surgery that involved the chest cavity, or who have blood-clotting problems, are not good candidates for this procedure.
Thoracoscopy gives physicians a good but limited view of the organs, such as lungs, in the chest cavity. Endoscope technology is being refined every day, as is what physicians can accomplish by inserting scopes and instruments through several small incisions instead of making one large cut.
Description :
Thoracoscopy is most commonly performed in a hospital, and general anesthesia is used. Some of the procedures are moving toward outpatient services and local anesthesia. More specific names are sometimes applied to the procedure, depending on what the target site of the effort is. For example, if a physician intends to examine the lungs, the procedure is often called pleuroscopy. The procedure takes two–four hours.
The surgeon makes two or three small incisions in the chest wall, often between the ribs. By making the incisions between the ribs, the surgeon minimizes damage to muscle and nerves and the ribs themselves. A tube is inserted in the trachea and connected to a ventilator, which is a mechanical device that assists the patient with inhaling and exhaling.
The most common reason for a thoracoscopy is to examine a lung that has a tumor or a metastatic growth of cancer. The lung to be examined is deflated to create a space between the chest wall and the lung. The patient breathes with the other lung with the assistance of the ventilator.
A specialized endoscope, or narrow diameter tube, with a video camera or mirrored attachment, is inserted through the chest wall. Instruments for taking necessary tissue samples are inserted through other small incisions. After tissue samples are taken, the lung is re-inflated. All incisions, except one, are closed. The remaining open incision is used to insert a drainage tube. The tissue samples are sent to a laboratory for evaluation.
Preparation :
Prior to thoracoscopy, the patient will have several routine tests, such as blood, urine and chest x ray. Older patients must have an electrocardiogram (a trace of the heart activity) because the anesthesia and the lung deflation put a big load on the heart muscle. The patient should not eat or drink from midnight the night before the thoracoscopy. The anesthesia used can cause vomiting, and, because anesthesia also causes the loss of the gag reflex, a person who vomits is in danger of moving food into the lungs, which can cause serious complications and death.
Aftercare :
After the procedure, a chest tube will remain in one of the incisions for several days to drain fluid and release residual air from the chest cavity. Hospital stays range from two–five days. Medications for pain are given as needed. After returning home, patients should do only light lifting for several weeks.
Questions to Ask the Doctor :
How soon will you know the results?
When can I resume any medications that were stopped?
When can I resume normal activities?
What future care will I need?
Risks :
The main risks of thoracoscopy are those associated with the administration of general anesthesia. Sometimes excessive bleeding, or hemorrhage, occurs, necessitating a thoracotomy to stop it. Another risk comes when the drainage tube is removed, and the patient is vulnerable to lung collapse (pneumothorax).
Medical Test: Thoracoscopy
General information
Where It's Done |
Who Does It |
How Long It Takes |
Discomfort/Pain |
Hospital. |
Doctor (chest surgeon or pulmonary specialist) and surgical team. |
2-4 hours. |
Discomfort associated with general anesthesia; also chest discomfort after the procedure due to incision. |
Results Ready When |
Special Equipment |
Risks/Complications |
Average Cost |
2 days. |
Thoracoscope and surgical instruments; general anesthesia. |
Risks associated with general anesthesia and surgery. |
$$$ |
Other names
Pleuroscopy:
Purpose :
To inspect abnormalities in the lung that require a surgical biopsy.
To obtain lung tissue for examination to confirm or rule out lung diseases, including lung cancer.
To investigate causes of unexplained fluid in the pleural cavity.
How it works :
A flexible tube that resembles a miniature telescope, a tiny camera, and surgical instruments are inserted through three tiny incisions in the chest wall, allowing the surgeon to view and take samples from the lungs.
Preparation :
Prior to the test, you will have a chest X-ray, electrocardiogram (if you are over age 35), and various blood tests. An arterial blood gas and a pulmonary function test may also be done.
You must fast for 12 hours before the procedure.
General anesthesia is administered, and preparations for chest surgery are made.
Test procedure :
The surgeon makes several incisions in your chest and inserts suction tubes that remove blood during the surgery.
A bronchoscope is inserted into the airway to check for anatomical abnormalities (see the discussion of bronchoscopy above).
A Y-shaped endotracheal tube with two inner tubes connected to a ventilator (breathing machine) is passed down the throat, and one end is inserted into each bronchus. The lung to be examined is allowed to partially deflate (during the procedure you will breathe through the other lung). This creates a space between the lung and chest wall that provides the doctor with a good view of the lung and inner chest structures.
The thoracoscope, a viewing tube that has a light source and may be flexible or rigid, is inserted into the space between the lung and the chest wall. The camera displays the image on TV screens.
The doctor examines the surface of the lung, makes a cut through the pleura, and removes tissue samples of the pleura and the lung. Biopsies can also be taken of any accessible structures and tissues.
If a cancerous tumor is suspected, a biopsy sample is sent to the pathology lab for a "frozen section," the results of which are 95% accurate. If it is positive for cancer, open chest surgery may be performed to remove the malignancy and part or all of the lung. (The final pathology report takes three to seven working days.)
After the test :
The lung is reinflated, and two of the incisions are closed. A tube is placed in the third, which will remain in place for one to several days to remove air and fluids from the chest. When drainage of the fluid stops, the tube is removed.
After one to two hours in the recovery room, you return to your hospital room for two to five days of recuperation.
After discharge, refrain from lifting anything heavier than a phone book for two to three weeks.
Factors affecting results
Accurate selection of the biopsy site.
Interpretation
The doctor may make the diagnosis by observing the structures in the chest. The biopsy sample removed during the procedure is examined under a microscope and provides additional information. Additionally, cultures may be performed.
Advantages
It requires a smaller incision than open lung biopsy, and a shorter recuperation time.
It may provide definitive diagnosis.
Disadvantages
It's invasive.
It requires hospitalization of several days.
It's usually used only to evaluate lesions that are close to the surface of the lung.
It yields a smaller tissue sample than open lung biopsy.
