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There are several different procedures and surgeries that can be used to diagnose or treat mesothelioma, ranging from minimally invasive to major surgery. A thoracoscopy is a minimally invasive procedure that is used to look inside the chest cavity with a small camera or to perform surgical procedures with small instruments. This procedure can be used to diagnose conditions, rule them out, and to monitor the progress of disease.
A thoracoscopy may also be used as part of a surgical procedure for treatment of mesothelioma in what is called video-assisted thorascopic surgery, or VATS. The small camera helps guide the surgeon without the need to make a large incision or perform a more invasive surgery. The risks and complications are minimal as compared to the more invasive technique of entering the chest cavity, called thoracotomy.
What is Thoracoscopy?
Thoracoscopy is a minimally-invasive type of thoracic surgery. The thoracic region is the chest cavity and this surgical procedure gives access to the lungs, heart, pericardium, pleura, and nearby lymph nodes. Any of the thoracic areas that are affected by mesothelioma can be reached through thoracoscopy. There are exceptions to this, of course, 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 a more invasive surgery, like thoracotomy.
By making just a very small incision, a scope with a small camera, or a set of small surgical instruments can be inserted and used to diagnose disease, administer surgical treatments, or monitor disease. When connected to a camera, the image is projected onto a screen that the surgeon can use to guide the use of instruments while performing a procedure and to look at the inside of the chest cavity.
Thoracoscopy to Diagnose Mesothelioma
One of the most important uses of thoracoscopy for patients who may have mesothelioma is in diagnosis. Because the procedure is minimally invasive, it can allow a surgeon to look at the pleura, lungs, and other tissues without putting the patient at high risk for complications or side effects. The scope can also be used to remove a sample of tissue for a biopsy. That tissue sample can then be investigated by a pathologist to rule cancer out 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. They were able to accurately diagnose the cancer in all patients. Another study found that experts were able to diagnose 95 percent of a group of patients accurately using thoracoscopy.
Benefits of Thoracoscopy
A thoracoscopy is often an alternative to 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 in order to insert instruments for performing a scope-guided procedure.
The benefits over a more invasive surgery include a lower risk of traditional complications of surgery, like bad reactions to general anesthesia, bleeding, and serious 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
If you are undergoing a thoracoscopy, you should know how to prepare and what to expect during and after the procedure. 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 need to 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 30 minutes and two hours.
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. This is done to prevent or treat a buildup of fluid. You may also need to be monitored for lung function, to be sure 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.
As compared to major surgery that involves 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 normally from this procedure. Some possible complications are infections, bleeding, a punctured or collapsed lung, pneumonia, and damage to other organs.
A complication for cancer patients undergoing thoracoscopy is seeding of the insertion site and areas of tissue manipulated by the scope and surgical instrument with cancer cells. When these instruments come into contact with cancer cells, they can move them to previously unaffected tissues, essentially spreading the cancer. Though it is not common, giving the patient a dose of radiation 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, the risks of complications are much lower than with traditional surgery. It is a very useful strategy for doctors to have in the battle against mesothelioma.
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP
Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.