Thoracoscopy

Thoracoscopy, pleuroscopy or thoracic endoscopy is a medical procedure to diagnose and treat various lung conditions. 

If you or a loved one are scheduled for a thoracoscopy, learn more about the medical procedure and what to expect before, during and after.

What is a thoracoscopy?

Thoracoscopy is a minimally invasive procedure used to examine the inside of the chest cavity, including the lungs and the area around the lungs (pleural space). This technique uses only small cuts (incisions), resulting in less pain and a faster recovery than traditional surgery methods.

Thoracoscopy uses a thoracoscope, a thin, tube fitted with a light and a tiny camera. The thoracoscope is inserted through a small cut below the shoulder blade and passed between two ribs into the pleural space. 

Who performs thoracoscopy?

Thoracoscopy is typically performed by a thoracic surgeon who specializes in chest surgeries involving the lungs, esophagus (swallowing tube) and diaphragm (the muscle that helps you breathe). 

Thoracoscopy is part of video-assisted thoracic surgery (VATS), a minimally invasive chest surgery in which surgeons use video monitors to guide their procedures.

How is a thoracoscopy different from a thoracotomy?

Unlike thoracoscopy, which is minimally invasive, thoracotomy involves a large incision in the chest wall to access the chest cavity directly. It is generally performed when the surgeon cannot perform the procedure with a small cut.

Why might I need a thoracoscopy?

Thoracoscopy may be recommended for several reasons, primarily falling into three categories:

• Diagnostic: This involves examining and obtaining tissue samples (a biopsy) to diagnose various conditions, including lung cancer, mesothelioma, interstitial lung disease, pleural effusion (the buildup of fluid around the lungs), infections and inflammatory diseases. It also aids in the diagnosis of lung nodules or masses.
• Treatment of lung conditions: Thoracoscopy is used to treat various lung conditions. It can be used to drain excess fluid or air from the pleural space, which may happen due to pleural effusion or pneumothorax (collapsed lung). Thoracoscopy enables surgeons to insert drainage tubes or perform procedures like pleurodesis to prevent fluid from returning.
• Lung resection: Thoracoscopy is often used to perform resections (removal of cancerous parts of lung tissue). This may involve removing just the part of the lung that contains the tumor (wedge resection) or the lobe of a lung (lobectomy) if the tumor is bigger.

Possible complications of a thoracoscopy

A thoracoscopy is considered a safe and minimally invasive procedure. But like other surgical procedures it has some risks, including: 

• Bleeding
• Infection in the lung (pneumonia)
• Air leak through the lung wall
• Reaction to the medication (sedative and general anesthesia) that helps you relax and sleep
• Respiratory complications, like problems breathing and shortness of breath
• Pneumothorax
• Infection at the site of the incision
• Needing a thoracotomy

If you have any worries or questions about getting a thoracoscopy, it's important to talk to your provider. They’ll help you understand everything and ensure your safety during the procedure.

How to prepare for a thoracoscopy

Your provider will give you specific instructions on how to prepare, but here are a few steps to ensure everything goes smoothly:

• Sign a consent form: You may be asked to sign a form giving your provider permission to perform the procedure. Read the form carefully and ask your provider if anything is unclear.
• Adjust medications: Your provider may ask you to adjust or temporarily stop your medications and/or dosage, especially blood thinners, to reduce the risk of bleeding during the procedure. If you have ongoing conditions such as diabetes or heart disease, your provider will give you specific instructions about your medications.
• Fasting: You will need to stop eating or drinking before the procedure, typically starting the night before. Fasting helps ensure your stomach is empty, reducing the risk of problems like throwing up (vomiting).
• Testing: Your provider may order tests, such as blood tests, breathing tests, CT scans or an electrocardiogram, to assess your overall health and the condition of your chest.
• Make arrangements: Since you will be under sedation or general anesthesia for the procedure, you will need to have someone drive you home after the exam. Sedatives and anesthesia can affect your judgment and reflexes for the rest of the day, so do not drive or make any important decisions.

Let your provider know if you have allergies or reactions to medications, latex or tape and if you are pregnant or think you may be pregnant.

What to expect during a thoracoscopy

A thoracoscopy may be an outpatient (no overnight stay in the hospital) or inpatient (stay in the hospital) procedure. However, how it is performed may vary depending on your condition and your provider’s practices. 

In general, it follows this process:

• You will change into a gown and remove any jewelry or other objects. This ensures that you are comfortable during the procedure and allows your provider easy access to the area being looked at.
• You will lie on a bed or table and various monitors will be attached to monitor your vital signs, such as heart rate, blood pressure and oxygen levels. An intravenous (IV) line will be placed in your arm to give you medicine.
• You will be given general anesthesia through the IV or via a mask.
• During the thoracoscopy, the surgeon will make one or more small cuts, usually 1-2 cm long. These incisions serve as ports for the thoracoscope and other surgical instruments. 
• The surgeon will carefully insert a scope to examine the lungs, pleura (chest cavity), diaphragm and other areas of the pleural space. The camera allows the surgeon to see the area and biopsy, drain fluid or air, remove tumors or abnormal growths and perform other procedures.
• After the surgeon is done, the scope will be removed and the incisions will be closed with stitches or surgical glue.

The procedure may take 30 minutes to 4 hours, depending on why your provider is performing the procedure.

Recovery from a thoracoscopy

After the procedure, you’ll be taken to a recovery area, where you’ll rest until the medicine's effects wear off. Your health care team will monitor your vital signs to ensure no problems after surgery.

If you had general anesthesia or sedation, you may feel a little groggy or sleepy for a short time. You may notice your throat is sore or hoarse once the numbness wears off. You may also have pain at the site of the incisions.

For outpatient procedures

You will need to have someone bring you home after the procedure. Some centers will not discharge you to go home in a cab or ridesharing service. Talk with your health care team about the policy for using these services or other resources available for getting home.

For inpatient procedures

You will be observed in the hospital for a while before being sent home. If a chest tube was put in to draw off fluid, it may be removed in a few days after the draining has stopped. Your health care team will monitor for signs of complications, such as bleeding, infection or breathing problems. 

Your provider will give you specific post-procedure instructions. These may include information on when you can start eating and drinking, how to care for the incision site, any medications you need to take and any activities you should avoid. 

Call your provider immediately if you have any of the following:

• Fever and chills
• Coughing up blood
• Severe hoarseness or changes in voice
• Feel dizzy or faint
• Increased pain or redness around the incision

Call 911 or have someone take you to the nearest emergency department if you experience any of the following:

• Sudden chest pain
• Difficulty breathing and swallowing or gasping for air 
• Sudden loss of consciousness

How do I understand my results?

After your thoracoscopy, your health care provider will review what they found during the exam. If they took a tissue sample, the results may take some time to get.

Depending on the results, your provider may schedule a follow-up appointment to discuss the findings, treatment plans or further tests as needed. If you have questions about your results, ask your provider to help you understand.

Expert care 

At Banner Health, we provide comprehensive solutions for diagnosing and treating lung and respiratory issues. If you have questions about thoracoscopy or other procedures, contact us today. Your journey to better lung health begins with Banner Health.