What is a Thoracoscopy?
A thoracoscopy is a diagnostic procedure that is used to help doctors detect the presence of pleural mesothelioma. It is a less invasive procedure than a thoracotomy and is also known as VATS or Video Assisted Thoracoscopic Surgery. A thoracoscopy is generally recommended if the diagnostic results from a closed pleural biopsy i.e. thoracentesis, show clear cytology and the patient is still exhibiting mesothelioma symptoms and/or if a buildup of fluid continues to occur after a thoracentesis has been performed. A thoracoscopy enables doctors to get a clearer visual look at the pleural space between the chest wall and the lungs and, if mesothelioma tumors appear to be present, obtain a tissue sample for further analysis.
There are two types of thoracoscopy procedures performed today: surgical thoracoscopy and medical thoracoscopy. Surgical thoracoscopy requires general anesthesia and is sometimes recommended when there is a dual purpose for the surgery i.e. a need to obtain a biopsy sample and to perform treatment. A medical biopsy on the other hand is far less invasive and can be performed with local anesthesia. The sole purpose for this procedure, however, is to biopsy the pleural cavity.
What to Expect if Your Doctor Recommends Thoracoscopy
Prior to the procedure the doctor will most likely order some standard tests such as a chest x ray and blood and urine tests. During the procedure, the surgeon will make several small incisions in the chest area usually between the ribs. Once the incision is made, the surgeon will guide a tube with a tiny video camera on the end (also known as an endoscope) through the small incision. With the assistance of the endoscope, the surgeon can view the pleural area. If it looks like abnormal tissue or a tumor is present he/she will obtain a tissue sample to send to the lab for analysis. This operation takes between 2 to 4 hours.
As indicated above, a surgical thoracoscopy is a more invasive treatment requiring general anesthesia. Today, medical thoracoscopy is becoming a more commonly used procedure if obtaining a biopsy sample is the primary goal. Because this procedure can be completed on an outpatient basis it is less expensive than surgical thoracoscopy and very effective at allowing the doctor to obtain tissue samples from a number of locations in the pleural cavity.
Risks Associated with a Thoracoscopy
The risks associated with both types of thoracoscopy procedures are minor. There is always a risk with the administration of anesthesia which can provoke an allergic reaction or cause headache or nausea. There is also a risk of infection, injury to organs in the pleural space and respiratory failure. Most individuals tolerate the procedure well however.
MedlinePlus – U.S. National Library of Medicine and National Institutes of Health
Management of Malignant Pleural Effusions: American Thoracic Society, March 2000
Harvey I. Pass, John A. Dingell, Susan Vento: 100 Questions & Answers About Mesothelioma. (Jones and Bartlett Publishers, Inc., 2005)