What Is A Thoracoscopy?

What is a thoracoscopy?

A thoracoscopy is a surgical test used to examine the lungs and the space around the lungs (known as the pleural space). It can be used for a number of reasons or in combination with other techniques. For example, a thoracoscopy can be used for detecting signs of cancer when other tests prove to be inconclusive. It can also be used to drain fluid or air inside the pleural space which is known as pleural effusion. Another use for the procedure is examining the pleural space to help find a diagnosis when other tests are unclear. It is minimally invasive and seen as a better option when compared to thoracotomy (open surgery) due to the lower risks of complications.¹ 

To perform a thoracoscopy, a surgeon will make several small incisions with a scalpel between your ribs. The first incision allows the insertion of a small tube with a camera (known as a thoracoscope) into the pleural space. The other incisions can be used to insert tools needed to collect samples for biopsies to analyse the samples (if the thoracoscopy is being used to diagnose an illness or investigate a tumour). 

Medical applications of thoracoscopies 

A thoracoscopy can be used to monitor tumours in the pleural space and investigate whether they are benign or malignant (cancerous). This procedure can also be used to remove tissue samples from the lungs. Another use for the technique is to drain fluid and air in the pleural space before fitting a drain for any future fluid and/or air that may accumulate in the region. Fluid drainage is often needed to treat tuberculosis.²

Procedure and techniques 

You can undergo a thoracoscopy without the use of general anaesthetic. Instead, you will be given a sedative through an IV tube, meaning you will not feel the incisions but will still be awake.³ However, with more major surgeries like a video-assisted thoracoscopic surgery (VATS), then the recommendation is to use general anaesthetic.

Patient selection and preoperative assessment 

Your doctor will be able to tell you whether a thoracoscopy is the best course of treatment for you after examining you and taking your medical history. If you are scheduled for a thoracoscopy, you should follow the advice given to you by your healthcare provider regarding any preoperative preparation.

In line with this, you should discuss any medications you are currently taking with your doctor in case you need to stop taking it or swap it for an alternative medication before the procedure. This includes medication like blood thinners or anticoagulants (such as warfarin), which can increase your risk of heavy bleeding after the procedure. In any case, you should not make any changes to your regular medication without consulting your healthcare provider. 

You may also be asked to not eat or drink anything a certain number of hours before your procedure. 

The procedure 

Several incisions will be made in the spaces between your ribs, each between 1-2cm long. These incisions may be placed in the spaces between your fourth, sixth and seventh ribs. This will allow easier access for the thoracoscope and any other tools needed for the procedure. 

After the thoracoscope is inserted, the camera will be manoeuvred so that the surgical team can see inside the pleural space. They will be able to use that while removing samples for the biopsies or draining any fluid and air from the pleural space. 

After the thoracoscope is removed, some patients may require some sterile talc to be sprayed inside the pleural space. This is used to prevent the build-up of any future fluid in the pleural space. To further control fluid drainage, some patients may also have a semi-permanent drain inserted into the incision site. This drain will remain in the incision and will be managed with the help of community health care teams (such as district nurses). If this is the case for you, then your doctor will discuss all your options with you.

Benefits and risks

A thoracoscopy is a minimally invasive procedure compared to open surgery. There are minimal incisions made during the surgery and any incisions made are kept as small as possible. This allows a quicker recovery time and also reduces the risks of complications when compared to open surgery such as infection or heavy bleeding. 

However, like all surgical procedures, there are some potential complications that could occur during or after a thoracoscopy. Your doctor should inform you of any potential risks beforehand and discuss how to deal with them, should they occur. This can include:

• Infection at the site of the incision or your lungs
• Bleeding from the incision site 
• A buildup of fluid or air in the pleural space or lungs
• Collapsed lung

It is important to reiterate that a thoracoscopy is generally considered a safe and low risk procedure and any such risks or complications are uncommon. If you have any concerns, you should bring them up during your appointment or preoperative assessment. Your surgical team will be able to address any concerns you may have. If you experience any complications then it is important to seek prompt medical help. 

Recovery and post-operative care 

After the procedure, you will be taken to the recovery wing whilst any sedation or anaesthetic you have been given wears off. You will have a chest drain fitted to allow any fluid or air build-up to be removed. This can take between 2-4 hours. It is important to not move the bottle or disturb the tube. If you feel that the tube has moved, inform the nurse immediately. An x-ray will be used to determine when the chest drain can be removed. 

After your chest drain is removed, you may have a stitch at the incision that can be removed after 7 to 10 days. Some people are able to go home the same day as the procedure, but others are required to stay for longer. Your discharge time will be up to your doctor and the results of your X-rays. 

The results of any tests carried out during the procedure (e.g. biopsy results) will be available within a week or two. Waiting for test results can cause some anxiety, so it is important to seek support should you need it.

Comparison with other diagnostic and therapeutic methods 

One major benefit of a thoracoscopy is that it does require you to undergo general anaesthetic, which is commonly used in open surgeries.¹ This makes it suitable for individuals who do not tolerate or are allergic to general anaesthetic. A thoracoscopy also has a quicker recovery time and a lower risk of complications compared to open surgery. 

This procedure should not be confused with thoracentesis which involves piercing a needle into the pleural space to drain abnormal fluid build-ups. 

Advancements and ongoing research 

There is a significant benefit to using minimally invasive methods where possible due to the fact that there is a lowered risk of infection and other complications. There is some potential for research in improving the thoracoscope itself, making it more manoeuvrable and possibly increasing the amount of tools that can be put on the device. This would reduce the need for multiple incisions and also make it easier to collect samples for biopsies.⁴ 

Summary 

A thoracoscopy is a minimally invasive surgical procedure which involves making small incisions (1-2 cm long) between the ribs to reach the pleural space (the area inside the chest walls and surrounding the lungs). This is a particularly useful technique that can be used in different ways. One use of this technique is to use the camera attached to the thoracoscope to view the inside of the pleural space to aid in the process of getting a diagnosis when other tests have been inconclusive. It can also be used to remove samples from the lungs, pleural space or any tumours for a biopsy. Another use of the thoracoscope tube is to drain a buildup of fluid and/or air in the pleural space and/or the lungs. The incisions made during a thoracoscopy can also be used to fit a semi-permanent chest drain after the procedure to help manage any future build-up of fluid and air in the pleural space.