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
Contraindications
Contraindications to thoracoscopy and VATS are the same as those for thoracentesis How To Do Thoracentesis Thoracentesis is needle aspiration of fluid from a pleural effusion. It may be done for diagnosis and/or therapy. Diagnostic thoracentesis Indicated for almost all patients who have pleural... read more 
.
An absolute contraindication is
Biopsy is relatively contraindicated in patients with highly vascular cancers, severe pulmonary hypertension, and severe bullous lung disease.
Procedure
Although some pulmonologists do pleuroscopy, VATS is done by thoracic surgeons. Both procedures are similar to chest tube insertion How To Do Surgical Tube 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 . 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.
