A thoracoscopy is a procedure that involves the use of a thorascope; a thin, flexible tube with a light and small video camera on the end, that is surgically inserted into your chest so the doctor can visualize the cavity and treat diseases in the chest. At times, the visual indications of the disease do not confirm the diagnosis of the disease. To confirm the diagnosis, doctors can also carry out a biopsy during the procedure and perform the surgery for the resection of the affected masses if required. Using thoracoscopy for surgery instead of a thoracotomy decreases complications, pain, discomfort, and recovery time. A medical thoracoscopy is most commonly performed when multiple attempts at thoracentesis (a procedure involving the insertion of a needle to drain fluid from the lung cavity) have failed to achieve a diagnosis in patients with a recurrent exudative pleural effusion.
A thoracoscopy can be done for the following reasons:
-To find out why you are having lung problems
-Your doctor suspects something in your chest that needs to be checked.
-To treat small lung cancers by removing the part of the lung that is affected
-To remove fluid around your lung
-A thoracoscopy allows doctors to perform both diagnostic and therapeutic procedures during the procedure.
-A thoracoscopy allows doctors to sample lung tissue for a biopsy
-The thoracoscopy can be done when the patient is awake and sedated or when they are under general anesthesia
-As with all surgical procedures, this procedure comes with risks such as bleeding and infections
You will receive fluids and medication through an intravenous (IV) line. You will receive general anesthesia by an anesthesiologist during the procedure so you will be asleep. The anesthesiologist will insert a breathing tube to stop the function of the lung that is being treated. The cardiothoracic surgeon will make 1-4 small incisions, measuring 1-3 centimeters, in the spaces between the ribs. The number and position of the incisions will depend on the disease and the difficulty of the procedure. The cardiothoracic surgeon will then insert the video camera and carry out the treatment and/or remove a tissue sample for further analysis. The procedure can last between 1-3 hours.
Before the procedure you will undergo screenings and laboratory tests, such as lung function test, blood clotting test, electrocardiogram (EKG), and chest imaging to ensure you are ready for the procedure.
If you have a history of being prone to bleeding or excessive bleeding that is hard to stop or if you or a family member have bruises all over the body, please let the doctor know before the procedure.
Please let your medical team know about any allergies you have to medication, food, and any other substance/chemical.
On the day of the procedure, the area to be operated on will be shaved and cleaned.
You will need to fast for 8 hours before the procedure or as recommended by the doctor.
You may need to stop certain medication before the procedure. Please let your doctor know about all medications and supplements you are taking so your doctor can advise if any need to be stopped before the thoracoscopy.
On the day of the procedure, please bring all medication and supplements you regularly take to the hospital.
You will be asked to sign consent forms before the procedure. Please read all documents before signing them.
You will likely remain in the hospital for 1-4 days after the procedure. After the procedure, you will be watched closely to make sure you don’t have any problems. As the anesthesia wears off you may be groggy or confused for a few hours. When you wake up in the recovery room you will likely feel sleepy, confused, and thirsty. There will be an intravenous line in place to deliver fluids and medications. You will also be attached to equipment to measure your blood pressure and respiration. Make sure to practice breathing as you are advised by a nurse or physical therapist to help your lungs expand properly and to prevent pneumonitis. It is recommended that you try to practice breathing exercises every hour to make sure your lung function can return to normal faster. Nurses will support you in getting up and walking around as soon as possible after the procedure to encourage circulation and speed up recovery. If any drains are placed, they will need to be removed before you can go home.
-Pneumonia (infection in the lung)
-Needing to have a thoracotomy, where the chest cavity is opened with a larger cut, because the procedure could not be done with the smaller cut used by thoracoscopy
-Collapse of part of a lung (pneumothorax) - Your doctor will order a chest x-ray after the thoracoscopy to check for pneumothorax (or other lung problems). Some problems might go away on their own, but if they’re causing symptoms (such as trouble breathing) they might need to be treated.
-Infection of the incisions (cuts)
What are the travel recommendations?
You should plan to stay in Thailand for at least 2-3 weeks through the duration of your treatment.
It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure or from the day of the procedure to the day of your follow-up appointment.
When traveling by air, if you are seated in Economy Class, please choose an exit row or bulkhead seat for convenience in getting up and moving around every 15-30 minutes. Flex your ankles regularly to prevent deep vein thrombosis.
Please take all medication prescribed by your doctor. Carry the appropriate dosage of mediation in your carry-on luggage when you travel as well as a few extra doses in case of an emergency. Carry the prescription for all your medication to avoid problems at the airport.
What are the recommendations for me when I allowed to go home?
You will need to recover at home for 1-2 weeks. If you have any questions, please talk to your doctor or medical team.
Activity. Avoid activities that involve pulling or pushing, lifting heavy objects, and other strenuous activity. Avoid driving for 2-3 weeks as this can affect the incision.
Avoid sexual intercourse until the incision is healed.
Wound Care. When your doctor allows you to bathe, shower daily with soap. Dry the surgical wound well and keep it clean. Don’t apply any creams, lotions, or powders to the incision until it is fully healed and appears like normal skin. Please contact your doctor if the wound is inflamed or swollen, if the pain is worsening, or if the wound is leaking fluid or blood.
Diet. Your diet should be restricted in accordance to existing medical conditions.
Eat healthily to promote wound healing.
Exercise. Practice breathing continuously. Avoid strenuous exercise for at least 1-2 weeks.
Medication. If you are prescribed antibiotics, please take them until you finish them. Please take all medication as prescribed by your doctor.
Appointments. Please keep all follow-up appointments so your wound can be monitored and stitches removed. If you experience any abnormal symptoms, such as fever, difficulty breathing, worsening fatigue, coughing blood, etc., please see your doctor before the scheduled appointment.
What is the difference between a medical and a surgical thorascopy?
Surgical Thoracoscopy: This procedure requires the patient to be under general anaesthesia and is recommended when the thoracoscopic surgery has a dual purpose of diagnosis and treatment.
Medical Thoracoscopy: This procedure is far less invasive as compared to the surgical thoracoscopy, with only small incisions required to carry out the process. The only purpose of this procedure is to conduct the biopsy of the lungs, chest cavity or pleural cavity.
What are the possible abnormal findings that can be detected during the procedure?
While a thoracoscopic lung biopsy is generally carried out to identify the signs for pleural mesothelioma, other types of chest cancer can also be detected in the process. Thoracoscopy can also be used to diagnose chest diseases which other procedures have failed to identify.