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Thoracoscopy

Sometimes it is necessary for pleural mesothelioma patients to undergo exploratory procedures that give doctors a better look at the cancer and allow tissue samples to be taken. This helps determine other important facts about a patient’s case and aids in designing the best possible treatment approach. One of these diagnostic procedures is known as a thoracoscopy.

What is a Thoracoscopy?

In order to examine the inside of the chest area, doctors employ the use of a thoracoscope, a long thin tube that has a light and magnifying glass at its end. The tube is inserted through two or three small incisions in the chest area, which is just large enough to allow the tube to pass through.

Thorascopy can be used for visualization of the pleural area. In this case, it is often referred to as pleuroscopy. Surgical thorascopy is more often referred to as video-assisted thorascopic surgery (VATS) and involves the use of a tube that is attached to a camera. The former is performed under conscious sedation, often in a special procedures suite, while the latter demands general anesthesia and is performed in an operating room.

A Thoracoscopy is often used when less invasive tests fail to make a definitive diagnosis. It can assess for cancer, be used to take a biopsy for further examination, or may be employed in order to introduce medications into the lungs.

What to Expect During a Thoracoscopy

Though sometimes performed in an outpatient setting, thoracoscopy is more often conducted in the hospital under general anesthesia. Two or three small incisions are made between the ribs, minimizing damage to muscles and nerves. The patient is hooked up to a ventilator during the procedure.

If the purpose of the thoracoscopy is to examine a diseased lung, that lung is generally deflated to make room for examination. The ventilator helps the remaining lung perform the breathing. A tube is then inserted through one incision and any instruments that need to be used for tissue collection are inserted through another. When surgery is complete, the lung is re-inflated and all but one incision is closed. The remaining incision is fitted with a drainage tube, which will be removed at a later time, probably in about 48 to 72 hours.

Generally, patients who have a thoracoscopy remain in the hospital for up to five days. Pain medication is administered and the drainage tube will remain until the surgeon is satisfied that all excess fluids have been removed.  Risks after surgery include bleeding, infection, or the re-collapse of the diseased lung, known as pneumothorax.  

Sources:

1. http://www.cts.usc.edu/lpg-thoracoscopy-thethoracoscopyprocedure.html
2. http://www.merck.com/mmpe/sec05/ch047/ch047h.html