Thoracoscopy

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 chest cavity
• introduce medications or other treatment directly into the lungs
• treat accumulated fluid, pus(empyema) or blood in the spaces 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.

Description

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 tumour 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.

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.

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).

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