Medical Thoracoscopy

What is a medical thoracoscopy?

A medical thoracoscopy (also known as a pleuroscopy) is a medical examination that allows your doctor to visualise the space between your lung and the chest wall, called the pleural cavity. The pleural cavity allows the best performance of the lungs during breathing.

During the procedure, your doctor will insert a pleuroscope – a thin tube with a camera attachment – through the chest wall.

This procedure typically does not need general anaesthesia. Instead, you will be given conscious sedation that makes you sleepy and relaxed. Sometimes an ultrasound may be used to find the most suitable point for the pleuroscope entry.

Why do you need a medical thoracoscopy?

Your doctor may recommend a medical thoracoscopy to diagnose the cause of the abnormal build-up of fluid in your pleural cavity.

This examination allows your doctor to study your pleural cavity and collect tissue samples (biopsy) to diagnose the cause of the fluid build-up.

Medications can sometimes be sprayed onto the pleural surface during the procedure to stop fluid build-up from happening again (pleurodesis).

Who should not undergo a medical thoracoscopy?

A medical thoracoscopy may not be suitable for people with certain bleeding conditions. Your doctor will discuss with you if you are a suitable candidate for this procedure.

You should also inform your doctor if you have sleep apnea, as it can cause complications.

What are the risks and complications of a medical thoracoscopy?

Although a medical thoracoscopy is a keyhole procedure, it carries some risks and may lead to possible side effects. These include:

• Pain. Sedatives and pain killers will help relieve any pain or discomfort felt. You may occasionally experience brief episodes of chest pain for a few months after the procedure.
• Air leaking from the lung into the pleural space. This can cause the lung to collapse (pneumothorax).
• Bleeding can happen at the incision or biopsy sites, but it usually stops on its own. Inform your doctor if you are on blood-thinning medication.
• Infection in the pleural space.
• Allergic reaction to the drugs, equipment or materials used in the procedure.
• Surgical emphysema, which occurs when air leaks into the tissues under the skin.
• Pulmonary oedema, which is when your lungs get filled with fluid, causing breathlessness.

How do you prepare for a medical thoracoscopy?

Your doctor will advise you on how to prepare for your medical thoracoscopy. You may be asked to:

• Stop taking any blood-thinning medications or non-steroidal anti-inflammatory drugs (NSAIDs) as they may promote bleeding during the procedure.
• Abstain from food and drinks for at least 6 hours before the procedure. Sips of water may be allowed up to 2 hours before the procedure, only if you need to take medication.
• Refrain from smoking as it may lower your oxygen level during the procedure.

Your doctor may also order some tests to help determine the right spot to perform the medical thoracoscopy. These include:

• Chest X-ray
• Chest fluoroscopy
• Ultrasound
• Computerised tomography (CT) scan

What can you expect in a medical thoracoscopy?

Your doctor will likely recommend that you stay overnight in the hospital after your thoracoscopy. This allows you to be under close observation while you recover from the procedure.

Estimated duration

The procedure typically takes 90 minutes.

Before the procedure

The team will insert an intravenous (IV) line for administering sedatives during the procedure. They will also give you antibiotics to reduce the chances of infection.

You will be hooked up to a blood pressure monitor so your vital statistics can be monitored during the procedure. You will also be given oxygen through your nose or mouth to boost your oxygen level.

During the procedure

Your doctor will do an ultrasound scan of your chest to locate the best position to insert the pleuroscope. They will inject local anaesthesia to numb your chest.

One or two small cuts will be made on your chest for the pleuroscope to pass through. Your doctor will examine your chest from the camera images taken and extract biopsy specimens where necessary and drain away any fluid in your pleural cavity.

To complete the procedure, your doctor will close up the stitches.

After the procedure

You will be sent for a chest X-ray after the procedure. Your doctor will review the X-rays before you can be discharged from hospital.

If you are returning home after the thoracoscopy, you should arrange for a caregiver to accompany you home. It is unsafe for you to drive immediately after the procedure due to the sedatives administered.

Care and recovery period for a medical thoracoscopy

In general, you can resume your normal diet and activities 24 hours after the procedure. You may however need to refrain from strenuous physical activities for a few days while you continue recovering.

The thoracoscopy site may be tender or sore for a few days. Your doctor will likely prescribe you painkillers. Do not take non-prescribed medication as they may affect wound healing.

When to call your doctor

Inform your doctor if you experience any of the following:

• Fever of 38°C or higher
• Redness or swelling at the surgery site
• Blood or other fluid leaking from the surgery site
• Feeling breathless
• Coughing out blood
• Chest pain