thoracoscopy

Thoracoscopy is the endoscopic examination of the pleural space and chest cavity using a thoracoscope inserted through a small incision in the chest wall. The term encompasses both medical thoracoscopy (pleuroscopy), usually performed under local anesthesia with sedation, and surgical thoracoscopy, also known as video-assisted thoracoscopic surgery (VATS), typically done under general anesthesia with single-lung ventilation.

Indications include diagnostic evaluation of pleural effusions or pleural thickening, pleural biopsy to obtain tissue for cytology or histology, and assessment of suspected malignant disease such as mesothelioma. Therapeutic uses include drainage or decortication for empyema, talc pleurodesis or mechanical pleurodesis for recurrent pneumothorax or malignant effusions, and various lung or pleural procedures conducted through a thoracoscopic approach.

Technique overview involves placing one to three small ports on the lateral chest wall to introduce the thoracoscope and surgical instruments. The pleural space is inspected, and targeted procedures such as biopsy or therapeutic intervention are performed. Medical thoracoscopy typically uses local anesthesia with sedation, while VATS requires general anesthesia with lung isolation. Postoperative care includes chest drainage and imaging to assess air leaks or fluid output, with a plan for recovery and potential escalation to open surgery if needed.

Risks and complications can include bleeding, infection, pneumothorax, prolonged air leak, injury to lung or surrounding structures, and anesthesia-related events. The procedure is contraindicated in certain patients with severe coagulopathy, extensive pleural adhesions, or hemodynamic instability, and may be converted to open surgery if necessary.

History traces thoracoscopy to early 20th century work by Hans Christian Jacobaeus, who demonstrated diagnostic pleuroscopy for tuberculous disease. Today, thoracoscopy is a standard tool in thoracic medicine and surgery, offering high diagnostic yield and a spectrum of therapeutic options with shorter recovery compared to open procedures.