Thoracoscopy is a minimally invasive surgical technique used to examine and treat conditions within the chest cavity. The modern application is often called Video-Assisted Thoracoscopic Surgery (VATS). This procedure involves inserting a thin, camera-equipped instrument called a thoracoscope through small incisions in the chest wall. The goal is to gain direct visual access to the pleural space, lungs, and surrounding structures without requiring a large, open incision.
Defining the Procedure and Its Purpose
Thoracoscopy is performed for both diagnostic and therapeutic reasons, offering a less invasive alternative to open-chest surgery (thoracotomy). Diagnostically, the procedure allows physicians to examine the pleura and collect tissue samples (biopsies) from abnormal areas like nodules or masses. It is frequently used to investigate unexplained pleural effusion, which is fluid accumulation around the lungs, allowing for fluid analysis and targeted tissue sampling for cancer or infection.
The therapeutic uses of thoracoscopy involve treating specific conditions directly through the small incisions. Surgeons use this approach to drain large or recurrent pleural effusions and perform pleurodesis, which prevents fluid from reaccumulating. The technique is also effective for treating a collapsed lung (pneumothorax) and for removing small, localized tumors or lung sections, such as in a wedge resection or lobectomy. Compared to traditional surgery, the minimally invasive nature of VATS generally results in less pain, shorter hospital stays, and a quicker return to normal activities.
Preparing for the Procedure
Preparation for a thoracoscopy begins with comprehensive pre-operative testing. These tests typically include blood work, a chest X-ray, and an electrocardiogram (ECG) to assess heart and lung function. Depending on the patient’s overall health, pulmonary function tests may also be required to evaluate lung capacity and breathing mechanics.
Patients are instructed not to eat or drink anything for a specific period before the procedure to prevent complications related to anesthesia. It is important to discuss all current medications with the surgical team, as certain drugs, particularly blood thinners, may need to be temporarily stopped several days prior to minimize the risk of bleeding.
The Surgical Process
The thoracoscopy procedure is performed in an operating room under general anesthesia. Once the anesthesia takes effect, a tube is often placed into the airway to maintain breathing control, and the patient is positioned on their side to optimize access to the chest cavity. The surgeon then cleans the skin with an antiseptic solution and drapes the area.
The surgeon begins by making a few small incisions, often called ports, typically measuring between a quarter-inch and one inch, usually placed between the ribs. While some advanced centers use a single-port technique, multiple ports (two to four) are commonly used to allow for the insertion of different instruments. The thoracoscope, which transmits a magnified image to a video monitor, is inserted through one of these ports, providing the surgeon with a clear, real-time view of the chest interior.
Specialized, long-handled surgical instruments are inserted through the remaining ports to perform necessary actions, such as dissecting tissue, collecting a biopsy sample, or draining accumulated fluid. The video images guide the surgeon’s hands, allowing for highly precise movements within the chest cavity. If a lung lobe needs to be removed, the tissue is carefully detached and then removed through one of the slightly larger access ports, sometimes requiring a small extension of the incision.
Since the lung is intentionally kept deflated during the procedure to create working space, a flexible chest tube is inserted through one of the incisions at the end of the surgery. This tube connects to a drainage system, removing residual air, fluid, or blood from the pleural space and allowing the lung to fully re-expand. After the surgical instruments and thoracoscope are removed, the small incisions are closed with sutures or surgical tape, and the patient is moved to a recovery area.
Recovery and Potential Complications
Immediately after the thoracoscopy, the patient is monitored closely in a recovery area as the effects of general anesthesia wear off, which can sometimes result in temporary grogginess or a sore throat. Pain management is a focus, and medication is provided to control discomfort around the incision sites. Most patients feel pain, but it is well-managed and less severe than that associated with traditional open surgery.
The chest tube is the most common post-operative device and remains in place for a few days, depending on how quickly the lung re-expands and the amount of drainage. Nurses regularly check the tube to ensure the lung is properly reinflating and the drainage is resolving before it is removed at the bedside. The typical length of a hospital stay varies greatly based on the complexity of the procedure, ranging from a single overnight stay to about a week for more extensive surgeries like a lobectomy.
Patients are encouraged to start moving soon after the procedure to aid recovery and prevent complications like blood clots. Most people can resume light daily activities within one or two weeks, although a full return to normal activity may take up to four to six weeks. Potential complications include bleeding, a localized infection, or pneumonia. A persistent air leak or a collapsed lung can sometimes occur, which may require the chest tube to remain for a longer duration. In rare instances, if technical difficulties are encountered, the surgeon may need to convert the minimally invasive approach to a traditional, larger open-chest surgery (thoracotomy).