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Thoracoscopy or pleuroscopy

Principle

This technique involves exploring the chest cavity by means of an optical instrument and carrying out diagnostic or therapeutic procedures by this means.
An endoscopic camera is introduced via a skin incision about 1 cm long. A second or third opening is sometimes made in order to allow other instruments to be introduced. Direct observation of the pleural cavity allows selected pieces of pleura or lung to be removed, or the cavity to be cleaned, unstuck or emptied of any unwanted fluid built up there, or pleurodesis (definitive sticking of the two pleural sheets using a chemical or mineral substance) to be carried out to prevent recurrence of pleural effusion or pneumothorax.

 

Technical details of the examination:

 

Preparation

- Nil by mouth.
- Shaving of one side of the chest and the armpit.
- Stop taking aspirin one week before the examination.
- Anaesthesia of the skin and chest wall is carried out.

Contraindications

- Problems with coagulation (blood test and medical history).
- Severe respiratory insufficiency.
- Severe cardiac insufficiency.

Duration

30 minutes to 1 hour.

Inconveniences

- A few days’ stay in hospital (plus pre-operative examinations).
- Sedation and/or application of epidural anaesthetic (anaesthetist).
- A drain is left in the cavity via one of the skin openings and linked to a suction device that is kept in for a few days.
- If an epidural catheter is inserted, an anaesthetist oversees the procedure. He determines the drugs to be administered and their doses, and when the catheter will be removed, after discussions with the surgeon.
- The sutures or clips holding the openings together are taken out about ten days later.

Complications

- During the examination:
1. Bleeding (rare).
2. Need to convert to thoracotomy (adhesion between lung and pleura, tumour preventing inspection of whole of chest cavity).

- After the examination:
1. Chest pain (reason why the epidural remains in place for several days).
2. Raised temperature, around 38°C for two or three days.
3. Continued leakage from lungs, flow of fluid or infection requiring extended suction through the pleural drain(s), pleurodesis in addition, and even administration of antibiotics (rare).

 

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