Thoracoscopy is a procedure in which a thin tube is attached to a camera and inserted into the chest cavity through small incisions in the skin. Thoracoscopy can be used to collect tissue samples to diagnose lung cancer or mesothelioma (thoracoscopic biopsy), and is sometimes used to remove a portion of the lung (thoracoscopic wedge resection or thoracoscopic lobectomy). Thoracoscopic surgery is less invasive than open surgery, and requires much smaller incisions.
The doctor may use an ultrasound machine to help find the best place to put the thorascope in. Then the area of your chest wall where the tube goes in will be numbed with an injection of local anaesthetic, this may sting a little at first but then numbs the area so that you do not feel anything during the examination. One, or sometimes two, small cuts will be made in the side of your chest and the thorascope is passed through allowing us to see inside the chest. Some specimens are taken and any fluid inside the chest is drained away and if necessary the sterile talc is sprayed in. At the end of the procedure a plastic tube (a chest drain) is inserted through the cut to allow any fluid or air left inside to come out. The chest drain is attached to a bottle with water in it, which stands on the floor – sometimes this is attached to suction for a while. The chest drain is stitched to the skin so that it does not fall out and is covered with gauze and a waterproof dressing.
The advantages of thoracoscopy over thoracotomy include improvement in post-operative pain,and more rapid recovery from surgery. The smaller incisions create much less pain, and only require band aids for dressings. In patients who do not have lung resections, a chest tube (drain) may not be required, and the patient may go home on the day of surgery (see article on thoracicsympathectomy.)Recovery from thoracoscopy depends upon which operation was done using this technique. If a lung resection is performed, or if a chest tube is placed, then the patient must remain in the hospital for three to five days until drainage from the chest tube diminishes, and any air leak from the lung has healed. When the patient goes home, he or she is restricted from driving for a week or so, or until pain medications are no longer necessary. The effects of anesthesia will make the patient tire a little more quickly than usual. We usually see the patient back in the office in one to three weeks, or at any time that the patient perceives that there is a problem.
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