Thoracoscopy

What is a thoracoscopy?

A thoracoscopy is a common procedure to look at the surface of your lungs and the area around your lungs (pleural space). Your healthcare provider uses a thoracoscope (a thin camera with a light) to see these areas and take samples of lung tissue or lymph nodes. They can see your diaphragm, esophagus, chest wall and other areas as well.

Providers use thoracoscopy as part of video-assisted thoracoscopic surgery (VATS), a minimally invasive chest surgery. They can project images to a video monitor in the operating room while they work.

What type of procedure is a thoracoscopy?

When your provider uses a thoracoscopy to look at your lungs and the areas around them, that’s a medical procedure. They may call it a pleuroscopy to be clear about what they plan to do.

Thoracoscopy is diagnostic when it’s used to look in your chest or take samples (biopsies) of tissue.

Therapeutic thoracoscopy is used as part of minimally invasive surgery to treat a specific problem.

When is a thoracoscopy used?

Your healthcare provider can use a thoracoscopy or video-assisted thoracoscopy surgery when they need to:

• Get information they couldn’t get from a chest X-ray, CT scan or ultrasound.
• Remove some of your pleura (the inner layer of the chest wall).
• Remove damaged parts of your lung (lung volume reduction surgery).
• Take air pockets out of your lungs.
• Remove a cancerous part of your lung (lung resection).
• Drain extra fluid from your pleural space and use medicine to keep fluid from collecting again (pleurodesis).

If you have lung cancer or mesothelioma, you may need this procedure. Also, your provider may use a thoracoscopy when treating cancer in your thymus gland or esophagus.

Thoracoscopy vs. thoracotomy

A thoracoscopy procedure is less invasive than a thoracotomy, which involves a bigger incision.

A thoracoscopy has these advantages:

• Quicker recovery time.
• Less pain.
• Fewer complications.

You may need a thoracotomy if your provider can’t do what they need to do safely with a thoracoscopy.

Who performs a thoracoscopy?

Your pulmonologist can do a thoracoscopy, which is also called a pleuroscopy. However, a thoracic surgeon has to do video-assisted thoracoscopy surgery.

How do I prepare for a thoracoscopy?

A few days before your thoracoscopy, you may need to stop taking any medicine that can make you bleed more easily. Also, your provider may tell you not to eat or drink on the day of your thoracoscopy procedure.

How long does thoracoscopic surgery take?

Thoracoscopy surgery can take a half-hour to several hours. Your provider will need more time if they need to do something more involved than taking samples.

What to expect during a thoracoscopy

If you’re having video-assisted thoracoscopy surgery, your provider will give you general anesthesia. Thoracoscopy is rarely performed with sedation alone.

Your surgeon will follow these thoracoscopy procedure steps:

1. Give you medicine through an IV to sedate you or make you sleep through the procedure.
2. Put a tube in your throat so a machine can handle your breathing.
3. Make two or three cuts (smaller than half an inch) over your seventh, sixth and fourth ribs.
4. Put a thoracoscope into your pleural space.
5. Put other tools into the other incisions.
6. Perform surgery or take samples of areas that don’t look normal.
7. Take the thoracoscope and any other tools out.
8. Put a chest tube into your pleural space to get air out, which reverses your collapsed lung.
9. Close your incisions.
10. Wake you up and allow you to breathe on your own.

What to expect after a thoracoscopy

It’ll take time to feel alert after getting sedation or anesthesia. Your throat and mouth may be numb, too, and you can’t eat or drink while they feel that way. Because of the breathing tube, you may be hoarse or have a sore throat the day after your thoracoscopy procedure. Also, you may have some pain where your provider made incisions.

You can expect to have a tube in your chest for a day or two after your thoracoscopy if your provider took biopsies or drained fluid.

You’ll get a chest X-ray to make sure you’re not having any lung issues.

Most people are hospitalized after thoracoscopic surgeries while drainage tubes are in your chest. After some thoracoscopy procedures, it is safe to go home after a few hours of recovery. You will need a friend or relative to drive you home.

Is thoracoscopy painful?

Because you’re receiving anesthesia during your thoracoscopy, you won’t feel any pain during the procedure. Afterward, you can take medicine for pain at your incisions.

How long does it take to recover from a thoracoscopy?

You can start doing normal activities again within two weeks of your thoracoscopy. Full recovery usually takes four to six weeks.

Is thoracoscopy dangerous?

The estimated mortality rate for a medical thoracoscopy is 0.3%. The mortality rate for video-assisted thoracoscopy is slightly higher. Complication rates for both types range from 2% to 11%. This includes minor and major complications.

What are the risks of a thoracoscopy?

Thoracoscopy complications may include:

• Bleeding.
• Infection in your lung or incisions.
• Fever.
• Air in your pleural space or near your incision.
• Collapsed lung.
• Fluid around your lung.

What type of results do you get and what do the results mean?

Your provider can tell you if they were able to fix the issue you had. Also, with lab results, they can tell you if a spot is cancerous or harmless. If you have cancer, they can tell you where it falls on the cancer staging system.

It may take a few days for a hospital lab to examine your tissue samples.

When should I call my doctor?

Contact your healthcare provider if you get home after your procedure and have:

• Difficulty breathing.
• Fever.
• Chest pain.
• New swelling in the chest or neck.

A note from Cleveland Clinic

With a few small incisions, your provider can use a thoracoscopy to diagnose or treat problems inside your chest. Ask questions if you don’t have a clear understanding of the reason for your thoracoscopy. You may feel more at ease about your procedure if you know what to expect. Follow your provider’s instructions when preparing for your thoracoscopy and when recovering afterward.