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Thoracoscopy

Thoracoscopy is used to examine the inside of the thoracic cavity. Thoracoscopy is used to further evaluate patients with pulmonary, pericardial (the sac around the heart) and pleural (the lining of the chest) disease after performance of labwork, thoracic radiographs (X-rays), and other diagnostics. Thoracoscopy is often used as a less invasive alternative to thoracotomy (exploratory chest surgery).

Uses of Thoracoscopy:

In addition to allowing visual examination of organs in the thoracic cavity, thoracoscopy can be used to:

  1. Obtain tissue samples (biopsy) for cytologic and histologic evaluation. Samples are evaluated for inflammation, infection, fibrosis and cancer. Biopsy can aid in characterization the extent of disease. This generally takes three to five days.
  2. Less-invasively perform certain types of surgery, including pericardiectomy.

Procedure

Thoracoscopy is performed under general anesthesia. The patient is generally fasted for 12 hours prior to thoracoscopy to decrease the risk of aspiration of stomach contents into the lungs during anesthesia. After being anesthetized, the patient is placed in dorsal recumbency (on its back) and anesthetic monitoring equipment is attached. The patientís heart rate and rhythm, respiratory rate, blood pressure, carbon dioxide level and oxygen saturation level are closely monitored while under anesthesia to prevent and minimize anesthesia-associated complications.

After the patient is sterilely draped, three small (~1/2 inch) access ports are made through the chest wall so a camera and instruments may be inserted into the chest. If identified, fluid may be removed from the chest using suction for analysis and to improve visualization. Photos and videos may be collected of normal and abnormal structures for documentation and further study. A number of biopsy samples are generally collected from potentially abnormal organs for histopathology.

Thoracoscopy generally takes between 45 and 90 minutes depending on gross findings and number of samples collected. At the end of the procedure, the thoracoscope is slowly removed. The small incisions in the body wall are closed using absorbable sutures. Sometimes a chest tube is placed to help control fluid re-accumulation post-operatively. The patient is then recovered from anesthesia. Most patients remain hospitalized for 1 to 2 days after thoracoscopy, depending on the underlying disease process.

Risks and Limitations

Thoracoscopy is generally considered a safe procedure. In addition to risks or limitations of endoscopy in general, the most common complication is discomfort at the sites of instrument insertion. Rarely, severe hemorrhage (bleeding) may occur during the procedure, requiring conversion to a thoracotomy.


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