01. Thoracoscopy Overview
What Is a Thoracoscopy?
Doctors may use a thoracoscopy procedure to help diagnose pleural mesothelioma. It is a type of endoscopy, meaning doctors perform it to examine the inside of the body. A doctor may also use the procedure to collect tissue for a mesothelioma biopsy.
Patients may also hear a thoracoscopy procedure referred to as a pleuroscopy.
A thoracoscopy involves the use of an instrument called a thoracoscope. It is a thin tube with a light and a camera at the end. The doctor places the thoracoscope through a small incision to examine the lining around the lungs, called the pleura.
The procedure is effective at facilitating a mesothelioma diagnosis. In one study, it helped identify pleural mesothelioma in 92% of patients with the disease. It also has the benefits of being minimally invasive and having a low complication rate.
A mesothelioma doctor may perform a thoracoscopy by itself or as part of a VATS procedure. VATS stands for video-assisted thoracic surgery.
Video-Assisted Thoracic Surgery (VATS)
VATS is a procedure that uses both a thoracoscope and surgical tools to help diagnose pleural mesothelioma. Unlike a thoracoscopy, VATS involves a few small incisions – usually three or four. The thoracoscope is placed in one incision and surgical tools in the others. Like a thoracoscopy, it is considered a minimally invasive procedure.
VATS can be used to collect biopsy tissue to help diagnose mesothelioma. It is an effective diagnostic tool. One study found that biopsies collected by VATS correctly identified pleural mesothelioma in 95% of cases.
Doctors may also sometimes use VATS to perform surgical procedures to improve quality of life in patients. For example, surgeons in at least one clinical trial used VATS to remove part of the pleura in mesothelioma patients. Patients in this study showed improvements in pleural effusion symptoms and overall quality of life. Pleural effusion is a common mesothelioma symptom. It is a buildup of fluid between the layers of the lung lining, which can make it hard to breathe.
02. Thoracoscopy for Mesothelioma
Receiving a Thoracoscopy for Mesothelioma
Patients may receive a thoracoscopy to help diagnose pleural mesothelioma. A pulmonologist may perform a regular thoracoscopy. Thoracic surgeons perform VATS.
To prepare for a thoracoscopy, doctors may ask patients to stop taking certain medications that may make them bleed more easily. Patients may also have to stop eating and drinking for several hours before the procedure.
In general, a regular thoracoscopy consists of the following steps:
- The patient will lie on their side in the procedure room. The side receiving the procedure faces up.
- In many cases, the patient will receive local anesthesia and sedation. This keeps the patient asleep and comfortable through the procedure.
- The doctor may remove excess pleural fluid with a needle.
- The doctor introduces air into the pleural space. This causes safe, controlled pneumothorax, or lung collapse. Pneumothorax makes it easier for the doctor to see the tissue. When done in this controlled environment, it does not harm the patient.
- The doctor makes an incision and inserts the thoracoscope to view the pleural space. The doctor may also collect biopsy tissue.
- The doctor places a tube in the chest to help drain any remaining fluid or air.
In some cases, the doctor performing a thoracoscopy may use a substance or medication to achieve pleurodesis. This procedure removes space in the pleura where fluid can build up. This can help relieve symptoms of pleural effusion, like chest pain and difficulty breathing.
The entire thoracoscopy procedure can take anywhere from 30 minutes to several hours. In some cases, the patient may not need to stay overnight at the hospital after a thoracoscopy for mesothelioma.
Regular Thoracoscopy vs. VATS
- Patient usually receives local anesthesia.
- Doctor makes 1 small incision.
- Doctor inserts thoracoscope into the incision.
- Doctor can view pleural space and collect biopsy tissue samples.
- This may be an outpatient procedure.
- Patient receives general anesthesia.
- Doctor makes 3 to 4 small incisions.
- Doctor inserts thoracoscope and surgical instruments into incisions.
- Doctor can view pleural space, collect biopsy tissue and perform surgery.
- This is an inpatient procedure.
Who Is Eligible for a Thoracoscopy?
A mesothelioma doctor can determine if a patient is eligible for a thoracoscopy. Experts recommend patients undergo a careful evaluation before receiving this procedure. This may include a review of the patient’s medical history, imaging, pulmonary function tests and blood tests.
It is important that a patient has adequate space in the pleural cavity for a thoracoscopy. A doctor may perform a CT scan or ultrasound to determine that the layers of the pleura are not stuck together.
Patients will not be eligible for a thoracoscopy if their pleural space has collapsed because of:
- Pleural thickening with an unknown cause
- Previous pleurodesis
- Suspected mesothelioma that has fused the surfaces of the pleura
Some patients may not be eligible for a thoracoscopy, or may need to postpone the procedure, for other reasons, including:
- Persistent cough
- Poor overall health
- Recent heart attack
- Serious irregular heartbeat
Doctors can use other methods to diagnose mesothelioma in patients who are not eligible for a thoracoscopy. These may include a needle biopsy, imaging scans and blood tests. A doctor can determine the best way to diagnose a patient based on their individual case.
Where to Receive a Thoracoscopy
A mesothelioma patient should receive a thoracoscopy from a doctor experienced with the procedure. Qualified doctors are available at mesothelioma cancer centers throughout the country.
Mount Sinai Medical Center
Moffitt Cancer Center
Robert H. Lurie Comprehensive Cancer Center of Northwestern University
Mayo Clinic Cancer Center
Lung Institute at Baylor College of Medicine
University of California Los Angeles (UCLA) Medical Center
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03. Recovering From Thoracoscopy
What to Expect After a Thoracoscopy
Mesothelioma patients may recover in the hospital after a thoracoscopy. They may also receive follow-up care, like extra oxygen and removal of temporary drain implants. The recovery process varies among patients. Whether a patient receives a regular thoracoscopy or VATS can also affect post-procedure care. Recovery for these minimally invasive procedures is often faster than for more invasive surgeries.
For a regular thoracoscopy, doctors may insert a chest tube to help with drainage. The tube usually stays in place for one to two days. After the procedure, doctors generally recommend that patients take it easy for a week or two before resuming normal activity.
After a mesothelioma video-assisted thoracoscopic surgery, patients may receive extra oxygen and a chest tube. They will also be moved to a post-anesthesia care unit for observation.
A regular thoracoscopy may be an outpatient procedure. Patients who undergo VATS will likely stay in the hospital overnight and may stay under observation for several days.
Risks and Side Effects of Thoracoscopy
A regular thoracoscopy is generally considered a low-risk procedure. Postprocedural fever was recorded in 16% of patients. In 2% of patients, researchers observed pleural tears causing air leak and air trapped in the tissues under the skin. Serious but rare complications include hemorrhage, lung perforation and artery obstruction.
Recorded Side Effects of Thoracoscopy
- Air in blood vessels
- Air in the tissues under the skin
- Air leaking from the lung into the pleural space
- Fluid collection in the lungs
- Low blood oxygen
- Low blood pressure
- Lung or organ injury
- Reaction to the anesthetic
- Shortness of breath
- Spreading of cancer cells
A risk of both a regular thoracoscopy and VATS is tumor seeding. This refers to instances where an endoscopic device dislodges and spreads cancer cells. This has the potential to cause metastasis along the path where the doctor inserted the device.
To avoid risks caused by tumor seeding, doctors may make a thoracoscopic incision in the same location a future surgery would also make an incision. This allows subsequent doctors to cut out tissue along previous incisions to help remove any seeded cancer cells.
Mesothelioma thoracoscopy side effects may vary. A patient can discuss potential side effects with their doctor to know what to expect.
Resources for Mesothelioma Patients
04. Thoracoscopy Benefits
Benefits of Thoracoscopy
A thoracoscopy is a useful diagnostic procedure that has several benefits for mesothelioma patients. In one study using the procedure for pleural biopsies, thoracoscopy correctly identified mesothelioma in 92% of patients. A thoracoscopy also has the benefits of being minimally invasive with a low complication rate. A regular thoracoscopy may also be less expensive than VATS.
Compared to a more traditional thoracotomy, a thoracoscopy usually involves less pain, fewer complications and a faster recovery. In a thoracotomy, a doctor makes a large incision in the chest to collect samples to help diagnose pleural mesothelioma.
Researchers continue to look into thoracoscopy as a diagnostic tool. In an ongoing clinical study, doctors plan to perform periodic VATS on patients at risk of developing mesothelioma. The goal of this study is to detect mesothelioma early. Early diagnosis and mesothelioma treatment may help improve outcomes in patients.