Thoracoscopy or pleuroscopy

This technique consists in exploring the thoracic cavity with an optical instrument and, if necessary, performing diagnostic or therapeutic manoeuvres.

Direct observation of the pleural cavity allows for selected pieces of pleura or lung to be removed, the cavity to be completely emptied of the abnormal fluid that has accumulated there, to be cleaned and cleared of adhesions, and to perform a pleurodesis (definitive bonding of the two pleural sheets by means of a chemical or mineral substance), which is aimed to prevent the recurrence of a pleural effusion or pneumothorax.

The procedure can last from 30 minutes to one hour.

The patient is invited to fast and to stop taking aspirin one week before the examination (depending on the doctor’s advice). A shave of the hemi thorax and axillary cavity is required.

This procedure requires a few days of hospitalizations, along with pre-operative examinations. An anesthesia of the skin and chest wall is performed. An endoscopic camera is introduced through a skin incision of about 1cm. A second or third incision is at times made to enable the passage of other instruments.

A drain is left in the cavity through one of the skin incisions and connected to a suction device that is maintained for a few days. If an epidural catheter has been placed, the follow-up is made by an anesthesiologist. He or she determines the medication to be administered and its dose, as well as the time of catheter removal, after consultation with the surgeon.

The sutures or staples closing the orifices are to be removed about ten days later.

Sedation and/or the installation and monitoring of an epidural (anesthesiologist).

During the examination: potential bleeding and possible need for conversion to thoracotomy (adhesions between the lung and pleura, tumor preventing inspection of the entire thoracic cavity).

After the examination: chest pain may occur (the reason why the epidural is left in for a few days), as well as temperature peaks around 38°C for two or three days. The persistence of a pulmonary leak, a flow of liquid or an infection may be observed requiring prolonged suctioning of the pleural drain(s), completion of the pleurodesis, or even antibiotics (more rarely).

Coagulation disorders (blood test and anamnesis), severe respiratory insufficiency, and severe cardiac insufficiency are contraindications to this examination.