Thoracoscopy

Thoracoscopy is a surgical procedure done by your doctor to examine the space inside your chest cavity but outside of your lungs, called the pleural space. This is an invasive procedure that leaves a few small wounds. It may require a hospital stay for proper recovery, depending on the intensity of your procedure.

Thoracoscopy overview: types and uses

Thoracoscopy is used for both diagnosis and treatment.

During a semi-rigid thoracoscopy, a thin, flexible, lighted tube with a video camera on the end (thoracoscope) is inserted into a small incision made below your shoulder blade in between your ribs.

Sometimes, a rigid thoracoscope may be used during a rigid thoracoscopy to obtain larger tissue or fluid samples for a biopsy, or to remove larger tumors.

For diagnosis

Thoracoscopy can be used to look for problems in the lungs that may be causing symptoms of lung disease. It can also check an abnormal area of the lungs that was flagged on an imaging test such as an X-ray or CT scan.

In addition, it can be used to take biopsy samples of abnormal lung tissue, the chest wall, lymph nodes, or the lung’s lining (pleura). A thoracoscopy can also be done to collect a sample of pleural fluid for analysis (pleural biopsy).

A pleural biopsy checks for what may be causing the pleural effusion buildup, including conditions like infections, heart failure, kidney disease, or liver cirrhosis. If cancer is determined from the biopsy, the malignant pleural effusion will need to be drained.

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For treatment

Examples of thoracoscopic procedures include:

  • An infected lobe of the lung is surgically removed to treat larger tumors. This is usually done as a video assisted surgery, known as VATS lobectomy. During the procedure, your surgeon will make an incision on the side of your chest between your ribs. Your ribs are spread apart for your surgeon to see within the pleural cavity and to remove a large tumor.
  • Pleural effusion drainage (thoracentesis). A thoracoscope is used to drain accumulated malignant pleural effusion within your pleural cavity. Sometimes antibiotics will be administered at the same time. Sterile talc poudrage (talc pleurodesis) may also be administered to prevent the malignant pleural effusion from coming back.
  • Video-assisted thoracoscopic surgery (VATS procedure). Under general anesthesia, a thoracic surgeon makes three small incisions in the chest wall to insert the thoracoscope, allowing air to enter the pleural space and collapsing the lung (pneumothorax). When the thoracoscope is removed, a chest tube is placed to remove excess air in the pleural cavity, allowing the collapsed lung to re-inflate.
  • Wedge resection. To treat small lung cancers (also known as a lung nodule), the part of the lung containing a tumor (the wedge) is surgically removed.

What to expect during a medical thoracoscopy

Although your experience may differ depending on why you need a thoracoscopy test done or your current health conditions, the following are what typically happens during medical thoracoscopy.

Physician conferring with older male patientBefore the test

Your healthcare provider may perform preoperative tasks including blood tests, breathing tests, CT scans, or an electrocardiogram based on the procedure that will be performed.

They will also ask you about any medications or supplements you are taking, and about any allergies. They may ask that you stop taking blood thinners several days before your test, and may also request that you fast several hours before your procedure.

You will also meet with an anesthesiologist, who will discuss how your anesthesia will be administered, and your doctor will also outline what to do for postoperative pain control.

Follow your doctor’s instructions, and ask questions if you have concerns.

During the test

Depending on your procedure, your medical thoracoscopy may be outpatient (no need for a hospital stay) or inpatient (requiring a hospital stay for a few days).

For outpatient surgery, you will have a local anaesthetic thoracoscopy, possibly with mild sedation administered through an IV.

For an inpatient medical thoracoscopy, you will receive general anesthesia through an IV and go fully unconscious. In the operating room, you will be hooked up to a breathing machine during the surgery.

During medical thoracoscopy, a small cut will be made under your shoulder blade and between two ribs. The thoracoscope will be inserted through this incision. A smaller cut is made below the armpit on the same side to insert a cutting instrument. Your lung may be deflated so your thoracic surgeon can check for abnormalities, which will then be removed or biopsied and examined in a lab.

If pleural fluid needs to be drained, a third incision will be made in the lower part of your chest wall. A flexible catheter known as a chest tube will be placed to drain the pleural effusion.

Once the operation is complete, the instruments are removed and your incisions will be sealed. You will be taken off the breathing machine and out of the operating room to recover and wake up.

Thoracoscopic lung surgery usually takes between 30 to 90 minutes depending on what must be done.

After the test

Your doctor will watch you closely to make sure there are no initial problems after the surgery.

If you had general anesthesia, you may feel groggy or confused, and may notice your throat is sore or hoarse once numbness wears off. You may also experience pain at the site of the incisions.

If you have local anesthesia, you will be able to go home within a few hours, but unable to drive. A family member will need to get you home.

For surgery under general anesthesia, a hospital stay is required for 3-4 days. If a chest tube was inserted, it may stay in for a few days until pleural drainage has stopped.

If you had a biopsy during your surgery, the results should be ready in a few days. Some biopsy samples may take longer and will require follow up with your doctor.

After you are ready to go home, your doctor or nurse will give you instructions to follow after the test, such as what you can and cannot eat, what medications you may need to take, and how to take care of your incisions.

Does a thoracoscopy cause any complications?

Every medical procedure has risks of complications. Similar to thoracentesis, the following complications can arise from a thoracoscopic surgery or diagnostic procedure:

  • Bleeding.
  • Fever.
  • Infection at the incision sites
  • Pneumonia (lung infection).
  • Tissue damage if the lung is torn.

  • Spontaneous pneumothorax (when part of the lung collapses and air leaks into the pleural space). This can lead to sharp, stabbing chest pain and difficulty breathing.
  • Needing a thoracotomy – a larger chest incision – if the thoracoscopy was not successful. A thoracotomy may also be needed for further access to the pleural organs such as the lungs, heart, esophagus, or spine.

If you experience fever, pain, bleeding, or swelling after your procedure, please contact your doctor for further treatment or instructions on how to change your care to ease any lingering symptoms.