Thoracoscopy for lung conditions

Overview

Thoracoscopy is a minimally-invasive procedure that uses an instrument called a Thoracoscope to view the insides of the chest cavity or pleural cavity, and perform certain interventions. It’s a better alternative to incisional (open) surgery. It is an important element in a surgical procedure called Video-Assisted Thoracoscopic Surgery. In this article, we will learn more about Thoracoscopy.

Introduction

The chest cavity, also called the thoracic cavity, is an important area in the human torso that is enclosed by the spine, the ribs, the sternum (breast bone) and the diaphragm, which separates this space from the abdomen. This cavity contains the heart, lungs, oesophagus, thoracic aorta, thymus gland and some lymph nodes.

Within this chest cavity are 2 smaller cavities called the pleural cavities, or pleural space, one each surrounding the 2 lungs. The pleura is a thin layer of tissue that envelops the outside of the lungs and the inside of the chest wall. Between the layers of the pleura is a small amount of fluid called the pleural fluid.

When there is a disease or condition that affects any of the organs, glands or lymph nodes in the chest and pleural cavities, doctors can get a better idea of the same by examining the cavity thoroughly. Much before the advent of minimally-invasive procedures, doctors used to perform an open or incisional surgery called thoracotomy for this.

But the increasing popularity of minimally-invasive procedures and endoscopy resulted in thoracoscopy which uses an instrument called a thoracoscope. The thoracoscope is a long, thin and flexible tube that can be inserted into the chest or pleural cavities to examine them better. It has a light and a video camera fitted at one end. It can also be fitted with cutting or scraping tools required for certain interventions.

When is Thoracoscopy used? Who requires it?

To understand why the person is having lung problems such as breathing issues or coughing up blood
There is a suspicious growth or activity in the chest which must be checked
To get better information about an abnormal growth or area, compared to what is obtained from a chest x-ray, ultrasound or CT scan
Biopsy: To collect tissue samples from the lymph nodes, abnormal growth in lung tissue, the chest wall, or the pleura (which is the lining of the lung)
To rule out or confirm lung cancer and mesothelioma (cancer of the tissue that lines the lungs and certain internal organs, due to asbestos exposure)
To treat cancers: Thoracoscopy can be used to treat cancers of the thymus gland or oesophagus. In case of small tumours in the lung, that part of the lung can be removed (called wedge resection or lung resection). And when the tumour is larger, the entire lobe of the lung that is affected is removed (lobectomy).
There is fluid around the lungs: The pleural fluid can sometimes increase in volume in which case, thoracoscopy is done to drain out the excess fluid and send it to a lab to look for signs of cancer or infection. If the problem recurs, then thoracoscopy is done to inject medication into the pleural cavity (a procedure called pleurodesis).
To remove some part of the pleura lining the inside of the chest wall to look for signs of disease
To remove damaged parts of the lung (called lung volume reduction surgery)
Take remove air pockets out of the lungs

Also Read: Lung Cancer Screening Tests – when does one need it?

How is a Thoracoscopy done?

Thoracoscopy is an outpatient procedure where sedatives and local anaesthesia are used. The procedure takes and hour or two and the patient can leave the hospital the same or the next day.

BEFORE

The patient must stop taking medications such as blood thinners, vitamin supplements and alternative medicine a week before the procedure. The doctors will also check if the patient is allergic to any drug. A few hours before the procedure, the patient is not allowed to eat or drink anything. He/she will then be taken to the thoracoscopy room where the procedure will be conducted.

DURING

Sedatives are injected into the patient through an IV line hooked to the arm. A breathing tube is pushed down the throat gently and connected to a breathing machine. Some part of the air in the lung on the side where the procedure is being done will be removed. This will shrink that lung a bit and make examination easy. A small cut is made below the end of the shoulder blade and between the ribs. This is where the thoracoscope will be inserted and pushed to the chest cavity and moved around so that a thorough examination can be done. Images from the video camera in the thoracoscope will be visible on a computer monitor kept in the room.

If some interventions like a biopsy, or resection have to be done, then a second scope with cutting or scraping tools fitted at the end are pushed through an incision made in the underarm or armpit. If excess pleural fluid must be drained, a flexible catheter called the chest tube with sucking apparatus fitted at the end, is pushed through a cut made in the lower chest wall.

Once the necessary interventions are done, all the scopes and tubes are gently pulled out. The cuts are sutured and the wounds are dressed. The procedure can last between 30 to 90 minutes depending on the purpose.

AFTER

The patient comes out of sedation and may be groggy or confused for a few hours. The mouth and throat will be numb, so the person will not be allowed to eat or drink anything for an hour or two. There may be numbness, soreness or a hoarse voice for a day. The patient will be discharged the same day and in rare cases the next day. If a chest tube was inserted to drain out excess fluid, the same will remain for a few days.

Also Read: Lung Biopsy- Procedure and Recovery

What is Video-Assisted Thoracoscopic Surgery

Video-Assisted Thoracoscopic Surgery or VATS is a minimally-invasive surgical procedure done to diagnose or treat various conditions in the chest region. This includes:

Surgery to treat a condition called hyperhidrosis which is marked by excessive sweating
Surgery to treat conditions of the oesophagus, or even remove a part of the oesophagus (esophagectomy)
Surgery to correct hiatal hernia, a condition in which, the upper part of the stomach pushes upwards into the chest region through an opening in the diaphragm
Surgery to remove the thymus gland (thymectomy)
Certain procedures to treat conditions of the heart, spine, ribs and diaphragm

Thoracoscopy plays an important role in VATS due to the high-quality imaging and ease of achieving interventions, that’s possible with a thoracoscope.

Risks and Complications

Risks from Thoracoscopy are few and can be easily managed by a team of qualified doctors, in any reputed hospital.

Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.

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