Thoracoscopy
Thoracoscopy, also referred to as pleuroscopy, is a minimally invasive surgical procedure that allows healthcare professionals to examine the chest cavity using a thoracoscope, a small videoscope. This technique is notable for its ability to capture and display images of the surgical area on a computer screen, which aids surgeons in performing various operations. Unlike traditional open-chest surgery that requires large incisions, thoracoscopy utilizes several smaller incisions, which can result in less trauma, reduced postoperative pain, and shorter recovery times for patients.
Thoracoscopy serves both diagnostic and therapeutic purposes, enabling physicians to investigate conditions like pleural effusion or lung tumors, as well as to perform procedures such as lung biopsies and tumor removals. Patients typically undergo preprocedure tests, including imaging and blood tests, and are usually required to fast beforehand. The procedure is performed under general anesthesia, and the recovery period generally spans one to four days, with patients often resuming normal activities within three to four weeks. While the risks associated with thoracoscopy are relatively low, they may include complications such as fluid accumulation or infection. Overall, thoracoscopy is a valuable tool in modern thoracic medicine, enhancing patient care through its minimally invasive approach.
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Subject Terms
Thoracoscopy
ALSO KNOWN AS: Pleuroscopy, minimally invasive or video-assisted thoracic surgery
DEFINITION: Thoracoscopy is a form of endoscopy used to view inside the chest cavity with a thoracoscope (small videoscope). The thoracoscope transmits images of the surgical area onto a computer screen to guide surgeons during the procedure. Compared to open-chest surgery, which requires one large incision, thoracoscopy uses several smaller incisions to access the chest, thereby minimizing trauma, decreasing postoperative pain, and promoting a shorter hospital stay and a quicker recovery.
Cancers diagnosed or treated: Pleural effusion, malignant mesothelioma, lung cancer, mediastinal and pericardial tumors, and thymomas.
Why performed: Thoracoscopy may be used as a diagnostic procedure to determine the cause of a pleural effusion, perform a lung biopsy, or evaluate tumors. Thoracoscopy may be used to perform therapeutic procedures including thoracoscopic pneumonectomy, lobectomy, or wedge resection for lung cancer treatment; thoracentesis to drain excess pleural fluid; and removal of tumors in the esophagus, mediastinum, pericardium, or thymus.
Patient preparation: Preprocedure tests may include a chest X-ray and ultrasound, pulmonary function test, computed tomography (CT) scan, electrocardiogram (EKG), and blood tests. In general, patients must not eat or drink for eight hours before the procedure. Depending on the type of procedure to be performed, additional tests or patient preparations may be required.
Steps of the procedure: General anesthesia is used in most cases. The thoracoscope and surgical instruments are inserted through three or four small chest incisions between the ribs. The thoracoscope is manipulated to view the area, and the surgical instruments may be used to remove tissue. Video-assisted thoracoscopic surgery (VATS) has emerged as a minimally invasive method that produces more efficient results. Semi-rigid scopes with flexible ends and three-dimensional (3D) camera videoscopes have also advanced thoracoscopy.
After the procedure: A chest tube drains fluid and removes air that may have accumulated during the procedure. Cardiac function and blood oxygen levels are monitored, and chest X-rays evaluate lung reexpansion and chest tube placement. The hospital recovery period is about one to four days. The chest tube is removed, and the patient receives a follow-up schedule and homegoing instructions. The patient can generally return to full normal activity three to four weeks after discharge, though some operations may take up to twelve weeks of recovery time.
Risks: The risks of thoracoscopy include accumulation of fluid in the pleural space, fluid in the lungs (pulmonary edema), bleeding, infection, respiratory distress, pneumonia, and collapse of the lung (pneumothorax). The risk of death is very low.
Results: Pleural fluid removed during the procedure is analyzed in the laboratory, and the biopsy tissue is examined for malignancy. The type and extent of disease will help guide the patient’s treatment.
Bibliography
Shojaee, Samira, and Hans J. Lee. "Thoracoscopy: Medical versus Surgical—In the Management of Pleural Diseases." Journal of Thoracic Disease, vol. 7, no. Suppl 4, 2015, p. S339, doi.org/10.3978/j.issn.2072-1439.2015.11.66. Accessed 23 June 2024.
“Thoracoscopy and Pleural Biopsy for Mesothelioma.” Cancer Research UK, 19 May 2023, www.cancerresearchuk.org/about-cancer/tests-and-scans/thoracoscopy-and-pleural-biopsy. Accessed 23 June 2024.
“Thoracoscopy - Thoracoscopic Surgery (VATS).” American Cancer Society, 14 Jan. 2019, www.cancer.org/cancer/diagnosis-staging/tests/endoscopy/thoracoscopy.html. Accessed 23 June 2024.
“Video-Assisted Thorascopic Surgery.” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/treatment-tests-and-therapies/video-assisted-thorascopic-surgery. Accessed 23 June 2024.
"Video-Assisted Thoracoscopic Surgery (VATS)." Mayo Clinic. Mayo Foundation for Medical Education and Research, 8 Mar. 2014.