Thoracoscopy is a minimally invasive surgical procedure in which a thin, lighted scope with a video camera is inserted into the chest through a small incision. Thoracoscopy allows the surgeon to view the outside of the lungs and the space between the lungs and the chest wall. During this procedure, the surgeon can remove small tissue samples for analysis to evaluate if a suspicious area is malignant (cancerous) or benign (not cancerous). The surgeon can also take a biopsy sample from nearby lymph nodes and the fluid surrounding the lungs to determine if cancer is spreading. Thoracoscopy is also known as thoracoscopic surgery, pleuroscopy, or video assisted thoracic surgery (VATS).1,2
Thoracoscopy is generally used in the examination of lung tumors that have remained undiagnosed after bronchoscopy or CT (computed tomography)-guided biopsy, as well as in the case of pleural tumors (those in the space between the lungs and the chest wall) and pleural effusions (the build-up of excess fluid around the lung). Minimally invasive surgical procedures, like thoracoscopy, minimize trauma to the body and result in less pain, shorter hospital stays, and more rapid recovery than open surgeries. Other potential benefits include less bleeding following the procedure and the reduced risk of infection.2,3
In addition to biopsy samples, other thoracoscopic procedures include:
- Wedge resection, in which a wedge-shaped portion of tissue is removed from the lung for diagnosis or treatment of lung nodules
- Drainage of pleural effusion, the excess fluid that can build up due to infection, cancer, heart failure, cirrhosis of the liver, or kidney disease
- Procedures to the mediastinum (middle of the chest between the lungs), pericardium (area surrounding the heart), or thymus (the gland located in the upper, central portion of the chest.2
What to expect
Thoracoscopy is a surgical procedure, and patients will undergo an examination and preoperative tests prior to the procedure, which may include blood tests, a pulmonary function test (breathing test), CT scan, and an electrocardiogram (measures the function of the heart). During the procedure, the patient is anesthetized, or put under general sedation. Several small incisions are made into the chest, and the thoracoscope is inserted. The camera at the end of the thoracoscope allows the surgeon to view images of the lungs and chest cavity on a video monitor. Surgical instruments are inserted through the other incisions. Following the procedure, one or more tubes may be placed in the chest to drain fluid and air, and then the incisions are closed with sutures (stitches) or staples.2,4
Possible side effects
Thoracoscopy is a safe procedure, with a low complication rate between 10% and 15%. Risks from thoracoscopy include wound infection, bleeding, air leaking through the lung wall, pain or numbness at the incision site, and pneumonia.4,5
Other tests used to diagnose lung cancer
Thoracoscopy is one testing procedure that may be used during the diagnosis process of lung cancer. Other tests that may be used include chest x-ray, CT scans, PET (positron emission tomography) scans, laboratory tests, thoracentesis, needle biopsy, sputum cytology, bronchoscopy, and pulmonary function testing.