thoracoscopy


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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]

tho·ra·cos·co·py

(thōr'ă-kos'kŏ-pē)
Examination of the pleural cavity with an endoscope.
[thoraco- + G. skopeō, to view]
References in periodicals archive ?
Studies indicated that malignancy developed more frequently in medical thoracoscopy (MT) than in VATS in the follow-up period of patients with nonspecific pleuritis in long-term outcome.12,13,18 Mesothelioma is the most common malignancy in these patients.21 In patients with pleural adhesions and/or fibrinous layer on the pleura, inadequate examination of the pleural cavity and difficulty in accessing the neoplastic tissue reduce the diagnostic success of MT, and VATS is recommended in such patients.22 VATS is performed under general anaesthesia in a lateral decubitus position.
Clinical-therapeutic management of thoracoscopy in pleural effusion: a groundbreaking technique in the twenty-first century.
Multiplanar CT can diagnose the condition accurately, although some authorities suggest thoracoscopy or laparoscopy as a gold standard.
Wang et al .[3] reported that the medical thoracoscopy is an effective and safe method for diagnosing pleural effusions of undetermined causes.
Literature reports several experiences about the efficiency and safety of thoracoscopy in the treatment of DE in terms of less ventilation impact and better outcomes (7,10-12,14-16).
If the parathyroid adenoma is located in the mediastinum, median sternotomy, thoracotomy, mediastinotomy, mediastinoscopy, or thoracoscopy may be required for resection, similar to other mediastinal masses (6-8).
If not yielding, invasive procedures like thoracoscopy and pleural biopsy are done.
He has been regularly performing bronchoscopy, medical thoracoscopy, ultrasound guided thoracocentesis, various other pulmonary procedures and sleep studies at tertiary care centres in India.
The hybrid approach uses video-assisted thoracoscopy to locate the tumour and remove it.
On the other hand, most exudative pleural effusions are difficult to diagnose and need initial thoracentesis followed by a series of biochemical, cytological and microbiological investigations and in some cases, it requires use of special diagnostic techniques such as computed tomography (CT) scan of thorax, pleural biopsy, bronchoscopy, and thoracoscopy.
The cervical approach will enable the resection of lesions in the neck and upper mediastinum, whereas large mediastinal lesions and lower or posterior mediastinal lesions will require thoracotomy, median sternotomy, or thoracoscopy. (15)