What Is a Thoracoscopy?
Thoracoscopy is a surgical procedure used to investigate the chest. Surgeons use a sterilized flexible tube called an endoscope inserted through a tiny incision. The tube contains a small fiber optic camera that allows them to view the lungs on a video monitor and perform a tissue biopsy.
Surgeons use an endoscope with small channels to look inside the pleural space. They can put tools in the channels and take tissue samples. Then, pathologists examine these samples under a microscope to see if the patient has mesothelioma or another type of chest cancer.
Another name for this surgery is pleuroscopy. If the doctors also perform a small operation, it’s often called video-assisted thoracoscopic surgery (VATS).
Overview of a Thoracoscopy for Mesothelioma
Before the procedure, your doctor will take a CT scan. This scan helps doctors determine where to look for any cancer and how to perform the surgery best.
The anesthesiologist gives you medicine to make you fall asleep. Doctors will help you lie down on your side and make a tiny cut near your shoulder blade. Then, they use air to deflate your lungs, making it easier for them to see what they are doing. They also insert different instruments, like an endoscope with a camera, through one or two small incisions on your side or back.
While manipulating the endoscope, surgeons view the inside of your chest on a video screen. If a biopsy or other surgical procedure is needed, your doctor will use additional gripping and cutting tools. For a biopsy, surgeons collect samples of normal and suspicious tissues for further study.
After the procedure, surgeons place one or more temporary tubes into the chest to drain fluid and air. Surgeons then close the incisions using sutures or staples.
The entire procedure generally takes between 45 and 90 minutes to complete.
In 2008, Joanne D. sought medical attention for pain she felt in her ribs and chest when she took deep breaths. She later developed a small pleural effusion. Several months later, the fluid was aspirated and did not show cancer, but rather an inflammatory process. Her symptoms escalated in October 2009. A CT scan showed suspicious areas in the left part of her chest, and doctors recommended she undergo an exploratory thoracoscopy with talc pleurodesis to stop the effusions. The pathology from that surgery rendered the mesothelioma diagnosis.
Surgical Consultation for Thoracoscopy
A thoracoscopy requires a doctor to check if you can have it done. During the consultation, your surgeon will discuss the procedure and answer any questions or worries. If there are any issues with your heart, you may need approval from a cardiologist.
Patients will learn more about how to prepare for surgery, including whether they should stop taking certain medications or supplements. They will also learn about the recovery process and how long it may take to recover fully.
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Recovery from a Thoracoscopy
After the procedure, the chest tube must remain in place for at least two to three days or until your lung fully expands without any leaks.
To help relieve pain, doctors will provide medicine orally or through an IV or chest tube. Nurses and respiratory specialists will encourage you to perform coughing and breathing exercises to prevent pneumonia.
Reasons to Consult a Doctor
- Chest pain
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Increased shortness of breath or difficulty breathing
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Fever exceeding 100.5 F
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Increased redness, drainage or swelling near incisions or chest tube
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Foul-smelling drainage from incisions
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A bubbling or sucking sound from an incision
You will return to the hospital for a follow-up with your doctor one to two weeks after surgery.
Risks and Complications
Few risks are associated with a thoracoscopy, and it is substantially less risky than a thoracotomy, a much more invasive open chest surgery also used to diagnose mesothelioma.
Potential Risks of Thoracoscopy
- Wound infection
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Severe bleeding
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Pain or numbness around incisions
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Lung inflammation (pneumonia)
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Air leakage through the lung wall
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Adverse reaction to anesthesia
Researchers initially voiced concerns about tumor seeding after thoracoscopy. This rare complication involves unintentional tumor spread as doctors pull cancerous cells into unaffected areas while manipulating the camera. One study determined that radiation therapy could prevent tumor seeding, the post-surgical complication of tumors forming at the surgical site. Thanks to preventative radiation therapy, there were zero instances of radiation seeding after the study’s 38 thoracoscopies.
Thoracoscopy Research
Research in the U.S. and abroad has demonstrated that this procedure is vital for diagnosing mesothelioma. Numerous studies report that diagnostic thoracoscopy is more straightforward, safer, less painful and virtually just as reliable as thoracotomy.
In one study involving 188 patients with pleural mesothelioma, doctors performed a thoracoscopy to obtain biopsy samples. A French panel of mesothelioma specialists later tested the biopsy results in the lab and confirmed the presence of mesothelioma in all patients.
Additionally, doctors were able to use tissue samples obtained during the procedure to identify the degree of cancer involvement in the patient’s visceral pleura, parietal pleura and diaphragm. The researchers could also determine the cancer stage for each patient.
Another study conducted in China included 19 patients suspected of having pleural mesothelioma. Researchers used thoracoscopy to correctly diagnose mesothelioma in nearly 95 percent of the cases studied.
U.S. researchers performed a retrospective study of 95 patients with pleural mesothelioma. After analyzing each patient’s mesothelioma subtype, the researchers diagnosed 75 with epithelial and 12 with biphasic mesothelioma.
Thoracoscopy correctly identified the mesothelioma subtype in 94% of epithelial and 20% of biphasic patients. The study confirmed this procedure as a cornerstone of diagnosing and staging pleural mesothelioma but found the technique less effective at identifying a patient’s histological subtype.
In a 2016 study published in the Annals of Thoracic Medicine, Italian researchers evaluated the trends in the use of thoracoscopy for patients with mesothelioma and other thoracic diseases.
They found that the accuracy of the procedure for diagnosing cancer increased from 57% to nearly 80% between 1984 and 2013. The study included 2,752 patients. Cancers, including pleural mesothelioma and lung cancer, represented more than half of the diagnoses.
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