Thoracoscopy

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 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 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 to five days. Medications for pain are given as needed. After returning home, patients should do only light lifting for several weeks.

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).

Resources

BOOKS

Atkinson, Lucy Jo, and Nancymarie Fortunato. Berry & Kohn's Operating Room Technique. St. Louis: Mosby, 1996.

Manncke, Klaus, and R. David Rosin. Minimal Access Tho racic Surgery. London: Chapman & Hall, 1998.

"Thoracoscopy." In Everything You Need to Know About Med ical Treatments Springhouse, PA: Springhouse Corp., 1996.

PERIODICALS

Shawgo, T., T.M. Boley, and S. Hazelrigg. "The Utility of Thoracoscopic Lung Biopsy for Diagnosis and Treatment." Chest 118, no. 4 (October 2000): 114s.

Dardes, N., E.P. Graziani, I. Fleishman, and M. Papale. "Medical Thoracoscopy in Management of Pleural Effusions." Chest 118, no. 4 (October 2000): 129s.

Tish Davidson, A.M.

Endoscope

—Instrument designed to allow direct visual inspection of body cavities, a sort of microscope in a long access tube.

Thoracotomy

—Open chest surgery.

Trachea

—Tube of cartilage that carries air into and out of the lungs.

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?