Thoracoscopy and Video-Assisted Thoracoscopic Surgery
Thoracoscopy is introduction of an endoscope into the pleural space. Thoracoscopy can be used for visualization (pleuroscopy) or for surgical procedures.
Surgical thoracoscopy is more commonly referred to as video-assisted thoracoscopic surgery (VATS).
Pleuroscopy can be done with the patient under conscious sedation in an endoscopy suite, whereas VATS requires general anesthesia and is done in the operating room. Both procedures induce a pneumothorax to create a clear view.
Thoracoscopy is used for
The diagnostic accuracy for malignant and tuberculous disease of the pleura is 95%.
Indications for VATS include
Less common indications for VATS are excision of benign mediastinal masses; biopsy and staging of esophageal cancer; sympathectomy for severe hyperhidrosis or causalgia; and repair of traumatic injuries to the lung, pleura, and diaphragm.
Contraindications are the same as those for thoracentesis.
An absolute contraindication is
Biopsy is relatively contraindicated in patients with highly vascular cancers, severe pulmonary hypertension, and severe bullous lung disease.
Although some pulmonologists do pleuroscopy, VATS is done by thoracic surgeons. Both procedures are similar to chest tube insertion; a trocar is inserted into an intercostal space through a skin incision, through which a thoracoscope is inserted. Additional incisions permit the use of video cameras and accessory instruments.
After thoracoscopy, a chest tube is usually required for 1 to 2 days.
Complications are similar to those of thoracentesis and include
Serious but rare complications include
Patients are also at risk of the complications of general anesthesia.