thoracoscopy


Also found in: Dictionary, Wikipedia.

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
Thoracoscopy is a procedure in which a physician can view the chest cavity and the lungs by inserting an endoscope through the chest wall. Thoracoscopy is less evasive than surgical lung biopsy.
Thoracoscopy is a procedure in which a physician can view the chest cavity and the lungs by inserting an endoscope through the chest wall. Thoracoscopy is less evasive than surgical lung biopsy.
(Illustration by Electronic Illustrators Group.)
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.

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 record 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.

Key terms

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.

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

Periodicals

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

thoracoscopy

 [thor″ah-kos´kah-pe]
examination of the pleural space with a thoracoscope.

tho·ra·cos·co·py

(thō'ră-kos'kŏ-pē),
Examination of the pleural cavity with an endoscope.
Synonym(s): pleuroscopy
[thoraco- + G. skopeō, to view]

thoracoscopy

an endoscopic procedure used to directly visualize the pleura, lungs, and mediastinum and to obtain tissue for testing. It is also helpful in staging and dissection of lung cancers.

tho·ra·cos·co·py

(thōr'ă-kos'kŏ-pē)
Examination of the pleural cavity with an endoscope.
[thoraco- + G. skopeō, to view]

thoracoscopy

examination of the pleural space with a thoracoscope.
References in periodicals archive ?
Total quantity or scope: Laparoscopy and thoracoscopy small animals kit - 1 piece.
While we firmly believe that sternotomy offers the optimal approach for cases that present with bilateral metastases, we have used both thoracotomy and thoracoscopy for other cases, depending on their mode of, and distribution at, presentation.
Despite repeated cytology, pleural biopsies and thoracoscopy, the cause of persistent undiagnosed effusions remains unknown in a small percentage of cases.
Since KS tends to involve only the visceral pleura, closed pleural biopsy is often non-diagnostic and the diagnosis requires thoracoscopy with the characteristic multiple cherry-red to purple appearance of the KS lesions on the visceral pleura.
Conventional thoracoscopy requires at least a 10 mm trocar (5), however we used a 5.
This technology is expected to set a new standard for medical displays, particularly for applications such as endoscopy, arthroscopy, laparoscopy, and thoracoscopy, as well as general surgery procedures.
15) More than 90% of specimens were from thoracoscopy or core needle biopsy (predominantly computed tomography-guided but also blind biopsy).
Radio-guided thoracoscopy seems to be an effective procedure with fewer complications and failures than other techniques.
AFB smear of pleural fluid obtained from video-assisted thoracoscopy showed 1-5 bacilli per high power field.
of California, San Francisco) sets medical thoracoscopy in context and celebrates its usefulness.
Video-assisted thoracoscopy is a safe procedure for obtaining adequate biopsies from several lobes.