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Thoracoscopy ˌthōr-ə-ˈkäs-kə-pē, ˌthȯr-

By Noah Lechtzin, MD, MHS, Associate Professor of Medicine and Director, Adult Cystic Fibrosis Program, Johns Hopkins University School of Medicine

Thoracoscopy is the visual examination of the lung surfaces and pleural space through a viewing tube (a thoracoscope). Thoracoscopy can also be used for certain surgical procedures. When it is used for surgery, the procedure is often referred to as video-assisted thoracoscopic surgery (VATS). The most common means for obtaining a sample of lung tissue for a biopsy is with a thoracoscope. A thoracoscope also may be used in treating accumulations of fluid in the pleural space (pleural effusions).

The person usually is given general anesthesia for VATS, but thoracoscopy can sometimes be done with the person awake but sedated. Then a surgeon makes up to three small incisions in the chest wall and passes a thoracoscope into the pleural space; this allows air to enter, collapsing the lung. Besides being able to view the lung surface and pleura, a doctor may take samples of tissue for microscopic examination and culture. In certain cases, the doctor may give drugs through the thoracoscope to prevent a reaccumulation of fluid in the pleural space. After the thoracoscope is removed, a chest tube is inserted to remove air that entered the pleural space during the procedure, enabling the collapsed lung to reinflate.

Complications are similar to those for thoracentesis and needle biopsy of the pleura. However, this procedure is more invasive, leaves a small wound, and requires hospitalization.