What is thoracoscopy?

Thoracoscopy is a procedure  used to look inside the chest cavity. This is done with a thoracoscope, a thin, flexible tube with a light and a small video camera on the end. The tube is put in through a small cut made near the lower end of the shoulder blade between the ribs. Thoracoscopy is sometimes called VATS which is short for video assisted thoracic surgery.

Why is it used

To find out why you are having lung problems

This test is used to look for the causes of problems in the lungs (such as trouble breathing or coughing up blood).

A suspicious area in your chest that needs to be checked

Thoracoscopy can be used to look at an abnormal area seen on an imaging test (such as a chest x-ray or CT scan). It also can be used to take biopsy samples of lymph nodes, abnormal lung tissue, the chest wall, or the lining of the lung (pleura). It is commonly used for people with mesothelioma and lung cancer.

To treat small lung cancers

Thoracoscopy can sometimes be used to treat small lung cancers by removing just the part of the lung that contains the tumor (wedge resection) or the lobe of a lung (lobectomy) if the tumor is larger. In certain cases it may also be used to treat cancers of the esophagus or thymus gland.

You have fluid around your lungs

Thoracoscopy can be done to remove excess fluid that is around the lung and causing trouble breathing. This fluid can also be sent to the lab and checked for cancer or infection. If fluid around the lungs is removed, but builds up again, medicine can be put into the chest cavity with a thoracoscope to keep the fluid from coming back (pleurodesis).

How is it done

Before the test

You may be asked to stop taking blood-thinning medicines (including aspirin) for several days before the test. You will be asked not to eat or drink anything for at least several hours before the procedure.

Getting the test

For this test, you will be given drugs through an intravenous (IV) line to put you in a deep sleep  (under general anesthesia). A tube will be put into your throat and hooked up to a breathing machine while the procedure is being done. A small cut is made in the back just below the tip of the shoulder blade between two ribs where the thoracoscope is inserted. Another small cut is made just below the underarm on the same side so the instrument with the cutting tool can be put in. Often, some of the air in the lung on that side may be released so it’s easier to see any abnormal areas. Then, any abnormal areas are removed or biopsied with the cutting tool and checked in the lab.

If fluid needs to be removed, a third cut is made in the lower chest wall and a flexible catheter (called a chest tube) is put in so fluid can drain out over a few days. The thoracoscope and cutting tool will then be removed and the cuts closed. Once the procedure is complete, you will be gently woken up and taken off the breathing machine.

The procedure can take between 30 and 90 minutes, but possibly longer, depending on what’s being done.

After the test

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. Your mouth and throat will probably be numb for a few hours. You won’t be allowed to eat or drink until the numbness wears off. Once the numbness is gone, you may have a sore throat, cough, or hoarseness for the next day or so.  You may have pain or numbness in the sites where the cuts were made.

Possible complications of thoracoscopy

Thoracoscopy risks include:

• Bleeding
• 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)
• Infection of the incisions (cuts)

A chest x-ray will be done 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.