Medical thoracoscopy, or pleuroscopy is a video-assisted procedure that enables the doctor to look inside the pleural cavity. In this procedure, a scope having a camera at its end is passed through a small incision in the chest to view the insides of the chest and the pleura and evaluate pleural diseases.
Pleura refers to the thin layer of tissue that lines the outer surface of the lungs and the inner surface of the chest wall. The space between the two pleural layers is called the pleural cavity/pleural spaces. Diseases of the pleura have a great impact on the lung function. The pleural space becomes filled with fluid in diseases which affect the pleura. This is called as pleural effusion.
The two types of thoracoscopy, namely, flexi-rigid and rigid thoracoscopy are widely used for the diagnosis of pleural effusions. Mini rigid scopes are a new generation thoracoscopes which combine the advantages of both the flexi rigid and the rigid scopes. A flexi-rigid thoracoscopy is 8mm in diameter while a mini-rigid thoracoscopy is 5.5 mm in diameter and enables pleural biopsy with a small incision.
The following are the indications of medical thoracoscopy:
- To take a pleural biopsy for diagnosing the cause of pleural effusion: Thoracoscopic pleural biopsy is considered the gold standard for diagnosing the cause of pleural effusions. It has a diagnostic yield of >98%.
- To perform adhesiolysis in loculated effusions: When pleural fluid remains in the pleural space for a long time, the fluid starts getting organized and loculated (formation of pockets within the cavity). Presence of such loculi hinder removal of fluid. Thoracoscopy can help us break such loculations easily.
- To perform talc poudrage pleurodesis: In case of recurring pleural effusion like in malignant pleural effusions, thoracoscopy can also be used to perform talc poudrage pleurodesis. During this procedure sterile talc is sprayed into the pleural cavity and this talc powder creates inflammation and makes the pleura stick to one another preventing reaccumulation of fluid.
The procedure of thoracoscopy involves the following steps:
The following are the measures to be taken care before undergoing the procedure:
- Before the procedure, the doctor will review your medical history to understand your overall health condition.
- The doctor will note down about your current medications .You would be advised to stop the use of blood thinning medications before several days of taking the test.
- You should stop eating food and drinking fluids few hours before the procedure as advised by the doctor.
- Before beginning the procedure, you will be administered drugs through your vein to make you fall asleep.
- Now, a thoracoscope is inserted through a small cut, which is made between the two ribs in the back below the tip of the shoulder.
- After removing the fluid from the plelura space, the pleura is visualized and abnormal tissue is removed and sent for biopsy.
- Once the procedure is completed, the cutting tool and the thoracoscope are removed, a chest drain is placed and the incisions are closed.
- After completion of the procedure, a clinical nurse will closely monitor you for a few hours until the anesthesia wears off.
- You will be given pain medications to relieve the discomfort caused by the procedure.
- Also, there may be pain and numbness at the sites where incisions were made.
- The doctor or nurse would give you certain instructions about the do’s and don’ts to be followed after going home.
- If the chest tube is retained to draw the fluid, it would be removed after a few days once the draining has completely stopped.