What is medical thoracoscopy?
Medical thoracoscopy is a procedure that helps a physician view the chest cavity and the lungs by inserting an endoscope/thoracoscope (camera with light source) through the chest wall. Thoracoscopy may be performed as a diagnostic or therapeutic procedure. It is also called a pleuroscopy.
Medical thoracoscopy shows a doctor a view of the chest cavity and lungs via endoscope.
The major indications for thoracoscopy are pleural and lung biopsies for lung diseases. Thoracoscopy is performed as a therapeutic procedure with the help of video technology. This is called video-assisted thoracoscopic surgery (VATS) and is performed by thoracic surgeons.
Anatomy of the lungs
During inhalation, air travels through the nose and/or mouth into the trachea (windpipe). The trachea further divides into two tubes called bronchus (bronchi). The bronchi open into the lungs.
Within the lungs, the bronchi branch out into smaller tubes called bronchioles. The end of bronchioles opens into little air sacs called alveoli, which aid in gaseous exchange. The alveoli are surrounded by blood vessels through which the exchange of gases, oxygen, and carbon dioxide take place.
Pleura is a thin membrane that lines the outer surface of the lungs (visceral pleura) and the inner surface of the chest wall (parietal pleura). The space between two pleura is called the pleural space or pleural cavity. The pleural space is filled with fluid. When this space is affected by pathologic disorders, it can lead to medical consequences.
Why is a medical thoracoscopy performed?
Some common indications for medical thoracoscopy include the following:
- Diagnosis of pleural effusions (excess fluid accumulation in the pleural cavity)
- Lung cancer staging
- Pleurodesis (adhesion of the visceral and parietal pleura)
- Biopsy of parietal pleura
- Staging for mesothelioma (the cancer of the lining of the lungs and chest wall)
How is medical thoracoscopy performed?
The procedure is performed under local anesthesia, intravenous sedation, or general anesthesia.
- A trocar (a thick needle) and cannula together are introduced into the pleural space.
- The trocar is removed and the thoracoscope is passed through the cannula (passage through the cannula ensures that no tissue residue covers the camera).
- This is a single-puncture technique, through which a thoracoscope (camera with light source) is introduced.
- There are two types of scopes: the rigid and the semi-rigid scopes. The choice of instrument depends on the indication of the procedure. In VATS, multiple small incisions are made on the skin above the chest cavity to insert a thoracoscope and surgical instruments.
What are the complications of medical thoracoscopy?
The procedure is relatively safe. Some complications that can occur are:
- Air leakage
- Respiratory failure
- Pneumonia (lung infection)
- Bleeding
- Atelectasis (collapse of the lung)
- Arrhythmia (irregular heartbeat/ abnormal heart rhythm)
- Myocardial infarction (heart attack)
- Deep vein thrombosis (DVT): Blood clot in deep lying veins
- Pulmonary embolism (PE): Blood clot in the lungs
- Pain and/or infection at the incision site
- Reaction to anesthesia