Thoracoscopy

Definition

Thoracoscopy is an endoscopic examination of the chest cavity. In the procedure, a specialized endoscope is inserted by a surgeon through a tiny incision in the patient's chest wall. Thoracoscopy is used to visually examine regions and organs of the chest cavity including the lungs, mediastinum, and pleura. When thoracoscopy is performed on a specific organ, it is often given another, more specific name. For example, when performed on the lungs it is called pleuroscopy.

Purpose

Thoracoscopy allows a physician to examine the interior of the chest cavity without making a large incision. Thus, it eliminates many possible complications that sometimes result from invasive procedures such as open chest surgery and surgical lung biopsy. The procedure also reduces pain, length of hospital stay, and recovery time at home. Thoracoscopy is performed to assess lung cancer; analyze possibly abnormal lung tissues; determine the cause of fluid in the cavity; treat accumulated air bubbles, blood, fluids, or pus; insert medications or other therapeutic treatments directly into the cavity; and remove adhesions (scar tissue). Thoracoscopy is often used to examine lungs and other organs that contain tumors or a metastatic growth of cancer.

Precautions

The surgical team must be aware of any potential patient who should not be considered for thoracoscopy. The procedure cannot be performed on anyone who cannot receive sufficient oxygen from only one lung (because one lung is deflated during the procedure). In addition, patients who had previous thoracic surgery or have blood-clotting problems are generally not suitable for thoracoscopy.

Thoracoscopy provides only a limited views of organs and regions of the chest cavity; primarily, it is only able to evaluate abnormalities near the surface of organs.

Description

Thoracoscopy is traditionally performed in hospitals and under general anesthesia but recently has been performed more frequently as an outpatient procedure and under local anesthesia. The procedure generally takes from two to four hours to perform.

The patient is positioned on his or her side on the operating table. The surgeon makes several (usually two to four) small incisions on the patient's side in the chest wall, usually spaced between the ribs to minimize damage to muscles, nerves, and ribs. A suction tube is inserted into one of the incisions to remove blood. A bronchoscope is inserted into the airway to check for structural abnormalities. A Y-shaped endo-tracheal tube (with two inner tubes) is inserted into the trachea, and one inner tube is inserted into each bronchus. The other end is connected to a ventilator. The lung is then partially deflated to create an empty volume between the lungs and chest wall. The patient breathes with a single inflated lung along with help from the ventilator.

An endoscope is inserted through one incision and surgical instruments inserted through other incisions. The doctor examines the surfaces of the areas and structures within the chest cavity, makes a cut through the pleura, and removes (as needed) biopsies, cultures, and tissue samples of the pleura, lung, and other areas. The remaining open incision is used to insert a drainage tube. When all examinations are completed, the deflated lung is re-inflated. All incisions are closed except for one to drain fluids and residual air. The incisions are closed with sutures or staples. Bandages are placed over the incisions to keep the area clean and to prevent infection.

The biopsies, samples, and cultures removed during the procedure are examined under a microscope. Samples are sent to a laboratory for analysis and evaluation. If a cancerous tumor is suspected, biopsies are delivered to a pathology laboratory.

Preparation

Patients who undergo thoracoscopy usually have all or some of the following preliminary procedures performed: chest x ray, electrocardiogram (anyone over 35 years of age), various blood and urine tests, pulmonary function analysis, and arterial blood gas analysis.

No foods or liquids should be consumed for twelve hours before the thoracoscopy because the anesthesia can cause vomiting. The physician should be informed of any medications taken by the patient, especially aspirin, blood pressure medicine and heart pills, diabetes pills and insulin, and ibuprofen.

Aftercare

The patient remains in the recovery room for about one to two hours after the surgery. When drainage of fluid stops, the tube is removed. The patient will remain in the hospital several days (two to five days, on average) to recuperate. Medications will be given on an as-needed basis. Patients should rest when returning home and should lift only light objects for at least one month.

Complications

The main complication comes from the use of the general anesthesia. Another complication that sometimes occurs is excessive internal bleeding. Blood clots can form and travel to the lungs. A lung may also deflate (pneumothorax) when the drainage tube is removed. There is usually some chest discomfort after the procedure because of the surgical incisions.

Results

A partial diagnosis can be made by observing the internal structures of the chest cavity. A normal chest cavity contains a small amount of lubricating fluid. Normal functioning lungs will appear free of abnormalities. An abnormal chest cavity will show excess fluid. Abnormal looking tissue will be biopsied to determine if it is malignant. Results of the biopsy will be returned from the laboratory for the physician to determine any future course of action. If cancer is found in any biopsies, open chest surgery may be performed to remove the malignancy.

Health care team roles

The health care team performs preliminary tests on the patient in preparation for surgery. The surgeon (usually a chest surgeon or pulmonary specialist) and the surgical team perform the procedure usually in a hospital. The health care team will follow up with post-surgical care. A member of the health care team will inform the patient about the results of the procedure.

KEY TERMS

Biopsy— Removal of sample of living tissue for examination.

Bronchoscope— Flexible tube less than 0.5 inches (1.3 centimeters) wide and about 2 feet (0.6 meters) long that is inserted into the trachea during a diagnostic procedure called bronchoscopy.

Bronchus— Tube leading from trachea to a lung.

Endoscope— Illuminated optic instrument with long, narrow-diameter tube (which may be rigid or flexible) that is attached to camera, which allows a surgical team to view inside chest cavity on video screen.

Endoscopy— Process to view interior of body.

Endotracheal— Within or passed through windpipe (trachea).

Mediastinum— Region in chest containing heart, trachea, and other organs that separate the two lungs.

Metastatic— Malignant.

Pleura— Membrane surrounding the lungs.

Thoracic— Of or about chest cavity.

Ventilator— Mechanical device that assists patient with breathing.

Resources

BOOKS

Shannon, Joyce Brennfleck, editor. Medical Tests Sourcebook: Basic Consumer Health Information about Medical Tests. Detroit, MI: Omnigraphics. 1999.

Shtasel, Philip. Medical Tests and Diagnostic Procedures: A Patient's Guide to Just What the Doctor Ordered. New York: HarperPerennial, 1991.

Zaret, Barry, editor. The Patient's Guide to Medical Tests. New York: Houghton Mifflin Company, 1997.

OTHER

Health A to Z, Medical Network, Inc. "Thoracoscopy," 2002.http://www.healthatoz.com/healthatoz/Atoz/ency/thoracoscopy.jsp (December 15, 2005).

HealthSquare, Physicians' Desk Reference. "Thoracoscopy: What You Should Know." http://www.healthsquare.com/mc/fgmc1001.htm (December 15, 2005).

Thoracoscopy

Definition

Thoracoscopy is the insertion of an endoscope, a narrow—diameter tube with a viewing mirror or camera attachment, through a very small incision (cut) in the chest wall.

Purpose

Thoracoscopy makes it possible for a physician to examine the lungs or other structures in the chest cavity, without making a large incision. It is an alternative to thoracotomy (opening the chest cavity with a large incision). Many surgical procedures, especially taking tissue samples (biopsies), can also be accomplished with thoracoscopy. The procedure is done to:

• assess lung cancer
• take a biopsy for study
• determine the cause of fluid in the chest cavity
• introduce medications or other treatments directly into the lungs
• treat accumulated fluid, pus (empyema ), or blood in the space around the lungs

For many patients, thoracoscopy replaces thoracotomy. It avoids many of the complications of open chest surgery and reduces pain, hospital stay, and recovery time.

Precautions

Because one lung is partially deflated during thoracoscopy, the procedure cannot be done on patients whose lung function is so poor that they do not receive enough oxygen with only one lung. Patients who have had previous surgery that involved the chest cavity, or who have blood clotting problems, are not good candidates for this procedure.

Thoracoscopy gives physicians a good but limited view of the organs, such as lungs, in the chest cavity. Endoscope technology is being refined every day, as is what physicians can accomplish by inserting scopes and instruments through several small incisions instead of making one large cut.

Description

Thoracoscopy is most commonly performed in a hospital, and general anesthesia is used. Some of the procedures are moving toward outpatient services and local anesthesia. More specific names are sometimes applied to the procedure, depending on what the target site of the effort is. For example, if a physician intends to examine the lungs, the procedure is often called pleuroscopy. The procedure takes two to four hours.

The surgeon makes two or three small incisions in the chest wall, often between the ribs. By making the incisions between the ribs, the surgeon minimizes damage to muscle and nerves and the ribs themselves. A tube is inserted in the trachea and connected to a ventilator, which is a mechanical device that assists the patient with inhaling and exhaling.

The most common reason for a thoracoscopy is to examine a lung that has a tumor or a metastatic growth of cancer. The lung to be examined is deflated to create a space between the chest wall and the lung. The patient breathes with the other lung with the assistance of the ventilator.

A specialized endoscope, or narrow—diameter tube, with a video camera or mirrored attachment, is inserted through the chest wall. Instruments for taking necessary tissue samples are inserted through other small incisions. After tissue samples are taken, the lung is reinflated. All incisions except one are closed. The remaining open incision is used to insert a drainage tube. The tissue samples are sent to a laboratory for evaluation.

Preparation

Prior to thoracoscopy, the patient will have several routine tests, such as blood, urine and chest x ray. Older patients must have an electrocardiogram (a trace record of the heart activity) because the anesthesia and the lung deflation put a big load on the heart muscle. The patient should not eat or drink from midnight the night before the thoracoscopy. The anesthesia used can cause vomiting, and, because anesthesia also causes the loss of the gag reflex, a person who vomits is in danger of moving food into the lungs, which can cause serious complications and death.

KEY TERMS

Endoscope— Instrument designed to allow direct visual inspection of body cavities, a sort of microscope in a long access tube.

Thoracotomy— Open chest surgery.

Trachea— Tube of cartilage that carries air into and out of the lungs.

Aftercare

After the procedure, a chest tube will remain in one of the incisions for several days to drain fluid and release residual air from the chest cavity. Hospital stays range from two to five days. Medications for pain are given as needed. After returning home, patients should do only light lifting for several weeks.

Risks

The main risks of thoracoscopy are those associated with the administration of general anesthesia. Sometimes excessive bleeding, or hemorrhage, occurs, necessitating a thoracotomy to stop it. Another risk comes when the drainage tube is removed, and the patient is vulnerable to lung collapse (pneumothorax ).

Resources

PERIODICALS

Dardes, N., E.P. Graziani, I. Fleishman, and M. Papale. "Medical Thoracoscopy in Management of Pleural Effusions." Chest 118, no. 4 (October 2000): 129s.

Shawgo, T., T.M. Boley, and S. Hazelrigg. "The Utility of Thoracoscopic Lung Biopsy for Diagnosis and Treatment." Chest 118, no. 4 (October 2000): 114s.

Thoracoscopy

Definition

Thoracoscopy is the insertion of an endoscope, a narrow diameter tube with a viewing mirror or camera attachment, through a very small incision (cut) in the chest wall.

Purpose

Thoracoscopy makes it possible for a physician to examine the lungs or other structures in the chest cavity, without making a large incision. It is an alternative to thoracotomy (opening the chest cavity with a large incision). Many surgical procedures, especially taking tissue samples (biopsies), can also be accomplished with thoracoscopy. The procedure is done to:

• assess lung cancer
• take a biopsy for study
• determine the cause of fluid in the chest cavity
• introduce medications or other treatments directly into the lungs
• treat accumulated fluid, pus (empyema), or blood in the space around the lungs

For many patients, thoracoscopy replaces thoracotomy. It avoids many of the complications of open chest surgery and reduces pain, hospital stay, and recovery time.

Precautions

Because one lung is partially deflated during thoracoscopy, the procedure cannot be done on patients whose lung function is so poor that they do not receive enough oxygen with only one lung. Patients who have had previous surgery that involved the chest cavity, or who have blood-clotting problems, are not good candidates for this procedure.

Thoracoscopy gives physicians a good but limited view of the organs, such as lungs, in the chest cavity. Endoscope technology is being refined every day, as is what physicians can accomplish by inserting scopes and instruments through several small incisions instead of making one large cut.

Description

Thoracoscopy is most commonly performed in a hospital, and general anesthesia is used. Some of the procedures are moving toward outpatient services and local anesthesia. More specific names are sometimes applied to the procedure, depending on what the target site of the effort is. For example, if a physician intends to examine the lungs, the procedure is often called pleuroscopy. The procedure takes two to four hours.

The surgeon makes two or three small incisions in the chest wall, often between the ribs. By making the incisions between the ribs, the surgeon minimizes damage to muscle and nerves and the ribs themselves. A tube is inserted in the trachea and connected to a ventilator, which is a mechanical device that assists the patient with inhaling and exhaling.

The most common reason for a thoracoscopy is to examine a lung that has a tumor or a metastatic growth of cancer. The lung to be examined is deflated to create a space between the chest wall and the lung. The patient breathes with the other lung with the assistance of the ventilator.

A specialized endoscope, or narrow diameter tube, with a video camera or mirrored attachment, is inserted through the chest wall. Instruments for taking necessary tissue samples are inserted through other small incisions. After tissue samples are taken, the lung is re-inflated. All incisions, except one, are closed. The remaining open incision is used to insert a drainage tube. The tissue samples are sent to a laboratory for evaluation.

Preparation

Prior to thoracoscopy, the patient will have several routine tests, such as blood, urine and chest x ray . Older patients must have an electrocardiogram (a trace of the heart activity) because the anesthesia and the lung deflation put a big load on the heart muscle. The patient should not eat or drink from midnight the night before the thoracoscopy. The anesthesia used can cause vomiting, and, because anesthesia also causes the loss of the gag reflex, a person who vomits is in danger of moving food into the lungs, which can cause serious complications and death.

Aftercare

After the procedure, a chest tube will remain in one of the incisions for several days to drain fluid and release residual air from the chest cavity. Hospital stays range from two to five days. Medications for pain are given as needed. After returning home, patients should do only light lifting for several weeks.

Risks

The main risks of thoracoscopy are those associated with the administration of general anesthesia. Sometimes excessive bleeding, or hemorrhage, occurs, necessitating a thoracotomy to stop it. Another risk comes when the drainage tube is removed, and the patient is vulnerable to lung collapse (pneumothorax).

Resources

BOOKS

Atkinson, Lucy Jo, and Nancymarie Fortunato. Berry & Kohn's Operating Room Technique. St. Louis: Mosby, 1996.

Manncke, Klaus, and R. David Rosin. Minimal Access Tho racic Surgery. London: Chapman & Hall, 1998.

"Thoracoscopy." In Everything You Need to Know About Med ical Treatments Springhouse, PA: Springhouse Corp., 1996.

PERIODICALS

Shawgo, T., T.M. Boley, and S. Hazelrigg. "The Utility of Thoracoscopic Lung Biopsy for Diagnosis and Treatment." Chest 118, no. 4 (October 2000): 114s.

Dardes, N., E.P. Graziani, I. Fleishman, and M. Papale. "Medical Thoracoscopy in Management of Pleural Effusions." Chest 118, no. 4 (October 2000): 129s.

Tish Davidson, A.M.

KEY TERMS

Endoscope

—Instrument designed to allow direct visual inspection of body cavities, a sort of microscope in a long access tube.

Thoracotomy

—Open chest surgery.

Trachea

—Tube of cartilage that carries air into and out of the lungs.

QUESTIONS TO ASK THE DOCTOR

• How soon will you know the results?
• When can I resume any medications that were stopped?
• When can I resume normal activities?
• What future care will I need?