The development of endoscopic video systems and instrumentation lead to the widespread use, by (thoracic) surgeons, of therapeutic thoracoscopy for a wide variety of major thoracic procedures.
Medical thoracoscopy is generally characterized as thoracoscopy performed under local anesthesia in the endoscopy suite with the use of non-disposable instruments, and is generally for diagnostic purposes.
Medical thoracoscopy/pleuroscopy is a minimally invasive procedure that allows access to the pleural space using a combination of viewing and working instruments. It also allows for basic diagnostic (undiagnosed pleural fluid or pleural thickening) and therapeutic procedures (pleurodesis) to be performed safely.
Interventional pulmonary procedures : Guidelines from ACCP
VATS vs MEDICAL THORACOSCOPY VATS Medical Thoracoscopy Operator Thoracic surgeon Pulmonologist Site OR Endoscopy suite/ OR Anesthesia GA Conscious sedation/LA MV Double lumen ETT, Single lung ventilation Spontaneous breaths Ports Multiple Single or double Indications
Thoracoscopy is the recommended procedure in patients with an undiagnosed effusion and negative pleural fluid cytology, who are suspected of having malignancy.
The diagnostic yield with thoracoscopy is over 90% in malignant effusions.
Pleurodesis can be performed during the same procedure if the biopsy is positive (on-site cytology during thoracoscopy), or if the macroscopic appearance is strongly suggestive of malignancy and adequate biopsies have been taken
4)Removal of fibrinopurulent membranes from the cavity and from parietal and visceral surfaces;
5) Cleansing of the pleural space with saline solution.
When the thoracic cavity has been emptied a careful exploration of the pleural surfaces is carried out and, if necessary biopsies performed. Finally a large-bore chest drain ( >28 F) is introduced, possibly under visual control, to remove dense and viscous pus or fibrin debris
Pleuroscopy allows the pleural cavity to be visualized under local anesthesia with sedation/intravenous anesthesia
Procedure of choice in the diagnostic workup of patients suspected of a malignant effusion with an indeterminate cytology
Allows for pleurodesis in the same setting
Physicians performing this procedure should have training requirements vary between institutions, but the operator should have sound knowledge of pleural and thoracic anatomy, and sufficient surgical skill.