A thoracoscopy is a minimally invasive procedure that gives surgeons a view into the chest cavity with a small camera on a tube called an endoscope. Doctors use the procedure to diagnose mesothelioma, monitor the progress of the disease, and as part of minimally invasive surgical treatments.
About Thoracoscopy
Thoracoscopy is a minimally invasive type of thoracic surgery. The thoracic region is the chest cavity.
What Is Thoracoscopy?
A thoracoscopy is a surgical procedure in which a thin tube with a camera is inserted through a small incision in the chest. The procedure gives access to the lungs, heart, pericardium, pleura, and nearby lymph nodes.
Thoracoscopy can reach most of the thoracic areas affected by mesothelioma. The procedure gives access to the lungs, heart, pericardium, pleura, and nearby lymph nodes.
Of course, there are exceptions to this if a tumor or other area of unusual tissue is difficult to access with a scope. In this situation, a surgeon may have to perform more invasive surgery.[1]
What Are the Uses for a Thoracoscopy?
A doctor can insert a scope with a small camera or a set of small surgical instruments by making a very small incision.
When connected to a camera, the image is projected onto a screen that the surgeon can use to look at the inside of the chest cavity and possibly guide the use of instruments while performing a procedure.[1]
There are several potential uses for a thoracoscopy:
- Diagnosing conditions of the chest cavity, including lung cancer and mesothelioma
- Removing a piece of tissue for a biopsy
- Draining fluid from the chest cavity or pleural space
- Removing cancerous tissue to treat mesothelioma or lung cancer
Is Thoracoscopy Major Surgery?
Thoracoscopy is considered minimally invasive, not major surgery. Minimally invasive procedures use small incisions and tools. They are less likely to cause complications and have shorter recovery times for patients.
Thoracoscopy vs Thoracotomy
Thoracotomy is a more invasive surgical procedure and is considered major surgery. It involves a large incision that gives surgeons greater access to the chest cavity and all the tissues and organs.
Like thoracoscopy, a thoracotomy may be used for diagnosis or treatment, but because it is so invasive, diagnostic uses are rare.
Pleural mesothelioma patients undergoing extensive surgery to remove cancerous tissue often need a thoracotomy.
VATS Thoracoscopy
If you or a loved one has lung cancer or pleural mesothelioma, you might hear the term VATS associated with thoracoscopy.
VATS stands for video-assisted thoracic surgery. Thoracoscopy, along with surgery, is a type of VATS that can be used diagnostically or as part of surgical treatment.
Who Is Eligible for a Thoracoscopy?
A patient’s doctor can determine if they are a good candidate for this procedure and if the benefits outweigh the risks. Having enough room in the pleural space is an important factor. If you are considering this procedure, your doctor may perform an imaging scan first to ensure this.
Some other reasons a patient might not be eligible for the procedure include a fever or infection, a recent heart attack, or poor overall health.
Using Thoracoscopy Surgery to Diagnose Mesothelioma
One of the most important uses of thoracoscopy for patients who may have mesothelioma is in diagnosis. A minimally invasive procedure allows a surgeon to look at the pleura, lungs, and other tissues without putting the patient at high risk for complications or side effects.
The surgeon can also use the scope to remove a tissue sample for a biopsy, often called a thoracoscopy with wedge resection. A mesothelioma biopsy is an essential part of diagnosing this condition, which can be difficult to differentiate from other types of cancer.
A pathologist uses the sample to rule out cancer as a cause of symptoms or to help make a diagnosis of mesothelioma or lung cancer.
Researchers have proven in several studies that using thoracoscopy to diagnose mesothelioma is highly accurate. In one study, pathologists and mesothelioma experts examined tissue samples taken by thoracoscopy from nearly 200 patients known to have mesothelioma.[2]
They were able to diagnose cancer in all patients accurately. Another study found that experts could diagnose 87.5% of a group of patients accurately using thoracoscopy.[3]
Thoracoscopy for Mesothelioma Treatment
Thoracoscopy can also be a treatment for pleural mesothelioma and other diseases of the chest cavity, like lung cancer. For mesothelioma patients, a thoracoscopy can be used for palliative procedures and other treatments.
Palliative care is any treatment that primarily focuses on managing symptoms and improving quality of life. Pleural mesothelioma palliative procedures that might require a thoracoscopy include:
- Draining fluid from the pleural space and chest cavity
- Inserting medication to prevent further fluid buildup
- Removing small amounts of cancerous tissue to relieve pain or other symptoms
Surgeons are less likely to use thoracoscopy for curative mesothelioma treatment. To try to slow cancer progression or achieve remission, surgeons need to remove a lot of tissue. A thoracoscopy is typically not adequate, and surgeons use a thoracotomy instead.
Benefits of Thoracoscopic Surgery over Thoracotomy
A thoracoscopy is often an alternative to a thoracotomy, which involves opening up the chest cavity with a large incision.
In contrast, for a thoracoscopy, the surgeon only needs to make a small incision, large enough to insert the scope or camera, and in some cases, a little larger to insert instruments for performing a scope-guided procedure.
The benefits over a more invasive surgery include:[4]
- It comes with a lower risk of traditional surgery complications, like bad reactions to general anesthesia, bleeding, and severe infections.
- While some patients will go under general anesthesia for a thoracoscopy, it is not always necessary. Some can undergo the procedure with only a sedative and no breathing tube.
- A thoracoscopy also allows for minimally invasive monitoring of the progression of mesothelioma. A surgeon can use the scope to check for changes to the pleura, growth in the tumors, or the formation of nodules.
What to Expect with a Thoracoscopy
If you are undergoing a thoracoscopy, you should know how to prepare and what to expect during and after the procedure:[1]
- You will undergo imaging studies, usually a combination of an X-ray, a CT scan, an ultrasound, or an MRI, before the procedure. This helps the surgeon identify the areas that must be investigated with the camera or sampled for a biopsy. For a treatment procedure, the image helps guide the surgeon’s instruments.
- An anesthesiologist will either administer general anesthesia or a sedative to get you ready for the procedure.
- Once adequately sedated and lying on your side, the surgeon will make a small incision on your back and insert the scope.
- The surgeon will see what is happening inside you by looking at a video screen.
- Typically, thoracoscopy procedures take between thirty minutes and two hours.
Thoracoscopic Surgery Recovery Time
Recovery from the thoracoscopy may take a few days. You may need to remain in the hospital with a chest tube in place to drain fluids from the chest cavity, which prevents or treats fluid buildup.
You may also need to be monitored for lung function to ensure that your lungs are expanding fully and that they were not punctured during the procedure. By one or two weeks after the procedure, you should be recovered and healed.
Potential Complications of Thoracoscopy
Compared to major surgery involving a large incision and the opening of the chest wall, a thoracoscopy is usually considered low-risk for patients.
There are potential complications, but most patients do not experience any more than the usual pain and shortness of breath that comes with recovering from this procedure. Some possible complications are infections, bleeding, a punctured or collapsed lung, pneumonia, and damage to other organs.[1]
A complication for cancer patients undergoing thoracoscopy is the seeding of the insertion site and areas of tissue manipulated by the scope and surgical instrument with cancer cells.
When these instruments contact cancer cells, they can move them to previously unaffected tissues, essentially spreading the cancer. Though it is not common, giving the patient a radiation dose can reduce the risk of seeding.
Thoracoscopy is one of the less invasive strategies surgeons and doctors have for diagnosing, monitoring, and surgically treating patients with mesothelioma. Because the incision and instruments are small, complications are much lower than with traditional surgery. It is a beneficial strategy for doctors in the battle against mesothelioma.
