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Thoracoscopy and Video-Assisted Thoracoscopic Surgery


Rebecca Dezube

, MD, MHS, Johns Hopkins University

Reviewed/Revised Nov 2023

Thoracoscopy is a procedure in which an endoscope is introduced to visualize 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.

Indications for Thoracoscopy and VATS

Thoracoscopy is used for

  • Evaluating exudative effusions and various pleural and lung lesions when less invasive testing is inconclusive

  • Pleurodesis in patients with recurrent malignant effusions when chemical pleurodesis is not indicated or has been ineffective

  • Breaking up loculations in patients with empyema

Common indications for VATS include

  • Bullectomy and lung volume reduction surgery in emphysema

  • Correction of spontaneous primary pneumothorax

  • Lobectomy and pneumonectomy (in some centers)

  • Lung parenchymal biopsy

  • Wedge resection

Less common indications for VATS are

  • Biopsy and staging of esophageal cancer

  • Excision of benign mediastinal masses

  • Repair of traumatic injuries to the lung, pleura, or diaphragm

  • Sympathectomy for severe hyperhidrosis or causalgia

Contraindications to Thoracoscopy and VATS

An absolute contraindication is

  • Adhesive obliteration of the pleural space

Biopsy is relatively contraindicated in patients with

  • Highly vascular cancers

  • Severe pulmonary hypertension

  • Severe bullous lung disease

Procedure for Thoracoscopy and VATS

Although some pulmonologists do pleuroscopy, VATS is done by thoracic surgeons. Both procedures are similar to chest tube insertion How To Do Tube and Catheter Thoracostomy Surgical tube thoracostomy is insertion of a surgical tube into the pleural space to drain air or fluid from the chest. Pneumothorax that is recurrent, persistent, traumatic, large, under tension... read more How To Do Tube and Catheter Thoracostomy . 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 and VATS, a chest tube is usually required for 1 to 2 days.

Complications of Thoracoscopy and VATS

  • Postprocedural fever

  • Pleural tears causing air leak and/or subcutaneous emphysema

Serious but rare complications include

  • Hemorrhage

  • Lung perforation

  • Gas embolism

Patients are also at risk of the complications of general anesthesia.


  • 1. Diacon AH, Van de Wal BW, Wyser C, et al. Diagnostic tools in tuberculous pleurisy: a direct comparative study. Eur Respir J 2003;22(4):589-591. doi:10.1183/09031936.03.00017103a

  • 2. Durgeshwar G, Mohapatra PR, Bal SK, et al. Comparison of Diagnostic Yield and Complications in Ultrasound-Guided Closed Pleural Biopsy Versus Thoracoscopic Pleural Biopsy in Undiagnosed Exudative Pleural Effusion. Cureus 2022;14(4):e23809. doi:10.7759/cureus.23809

NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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