Medical thoracoscopy/pleuroscopy is used increasingly by chest physicians and has become, after bronchoscopy, the second most important endoscopic technique in respiratory medicine
- Workup and diagnosis of idiopathic pleural effusions
- Staging of lung cancer
- Site-directed biopsy of parietal pleura
- Staging for mesothelioma
The thorcoscopy is performed usually under local anaesthesia with conscious sedation, but rarely general anaesthesia may be required/p>
After adequate sedation is achieved, the patient is positioned in the full lateral decubitus with the hemithorax up, padded comfortably, and secured to the table.
The site for pleuroscope entry into the pleural space is determined by surface anatomy landmarks, preoperative imaging studies, and physical examination to maximize visualization of the expected pathology.
The hemithorax is entered bluntly with a clamp passed over the rib and through the pleura With an adequate access space created, the pleural space immediately subjacent to the entry site is digitally inspected to ensure an adequate pleural space to safely insert the pleuroscope.
The pleuroscope is inserted under direct vision into the pleural space. Once the surveillance panoramic examination is completed, the specific purpose of the procedure (eg, evacuation of pleural fluid, pleural biopsy, or pleurodesis) is addressed.
Fluid is evacuated using suction catheters passed through the working channel under direct vision. Parietal pleural biopsy is performed with biopsy forceps passed through the working channel under direct vision
Once the examination and procedure are completed, the pleuroscope is withdrawn, a chest drain is placed, and the pneumothorax is evacuated
The complications include prolonged air leak, hemorrhage, subcutaneous emphysema, postoperative fever, empyema, wound infection, cardiac arrhythmias, reexpansion pulmonary edema, hypotension and seeding of chest wall in patients with mesothelioma.
The mortality rate associated with thoracoscopy performed is 0.09% or 1 death in 8000 procedures.