What is a Thoracoscopy Procedure?

Thoracoscopy Surgery for Mesothelioma | Treatment Procedure

A thoracoscopy is a medical procedure used to diagnose pleural mesothelioma, a rare but aggressive cancer linked to asbestos exposure. It falls under the category of endoscopy, where doctors examine the body’s interior. This procedure is also sometimes referred to as pleuroscopy.

The thoracoscopy involves the use of a specialized tool called a thoracoscope. This instrument consists of a slender tube equipped with a light and a camera at its tip. A doctor inserts the thoracoscope through a small incision to visually inspect the pleura, the lining around the lungs.

Key Points:

  • Thoracoscopy is an endoscopic procedure.
  • It utilizes a thoracoscope to examine the pleura.
  • Effective in diagnosing pleural mesothelioma.
  • Minimally invasive with a low complication rate.

Thoracoscopy for Mesothelioma

Patients suspected of having pleural mesothelioma may undergo a thoracoscopy, performed either by a pulmonologist or a thoracic surgeon. Preparation typically involves discontinuing specific medications that may increase bleeding risk and fasting for several hours before the procedure.

In a typical thoracoscopy:

  1. The patient lies on their side with the procedure side facing up.
  2. Local anesthesia and sedation are administered to keep the patient comfortable.
  3. The physician might extract extra pleural fluid using a needle.
  4. Controlled pneumothorax is induced by introducing air into the pleural space, aiding visibility without harm.
  5. An incision is made, and the thoracoscope is inserted to examine and collect biopsy tissue.
  6. A chest tube may be placed to aid drainage, and pleurodesis may be performed to alleviate pleural effusion symptoms.

The entire thoracoscopy procedure can vary in duration, ranging from 30 minutes to several hours. Hospitalization may not always be necessary after the procedure.

Regular Thoracoscopy vs. VATS:

  • Regular Thoracoscopy:
    • Local anesthesia.
    • One small incision.
    • Biopsy tissue collection.
    • Potentially outpatient.
  • VATS (Video-Assisted Thoracic Surgery):
    • General anesthesia.
    • Multiple small incisions.
    • Biopsy, surgery, and observation.
    • Typically inpatient.

According to the National Library of Medicine, a study of 546 patients who underwent surgery between January 2006 and December 2010, 240 (220 lobectomies and 20 segmentectomies) were diagnosed with clinical N0 adenocarcinoma. Of these, 135 underwent VATS and 105 underwent open surgery. Long-term oncological outcomes were compared between the two groups. Significant differences were found in age, gender, clinical T factor, and tumor size between the two groups. VATS procedures showed statistically longer operation times, reduced blood loss, shorter hospital stays, and fewer dissected lymph nodes compared to open surgery. Additionally, disease-free survival was significantly better in the VATS group compared to open surgery.

Who Is Eligible for a Thoracoscopy?

A mesothelioma specialist evaluates a patient’s suitability for a thoracoscopy, considering factors like medical history, imaging, lung function, and blood tests. Adequate space within the pleural cavity is essential for this procedure, determined by CT scans or ultrasound.

Patients may not be eligible for a thoracoscopy if pleural space is compromised due to factors such as pleural thickening, previous pleurodesis, or extensive mesothelioma growth fusing pleural surfaces. Other factors like fever, infection, cough, overall health, recent heart issues, or irregular heartbeat may also impact eligibility.

Alternative diagnostic methods include needle biopsies, imaging scans, and blood tests, tailored to each patient’s unique case.

Where to Receive a Thoracoscopy

It is crucial for mesothelioma patients to undergo thoracoscopy procedures under the care of experienced specialists. Qualified doctors are available at mesothelioma cancer centers nationwide.

Some notable centers include:

  • Mount Sinai Medical Center (New York, NY)
  • Moffitt Cancer Center (Tampa, FL)
  • Robert H. Lurie Comprehensive Cancer Center of Northwestern University (Chicago, IL)
  • Mayo Clinic Cancer Center (Rochester, MN)
  • Lung Institute at Baylor College of Medicine (Houston, TX)
  • University of California Los Angeles (UCLA) Medical Center (Los Angeles, CA)

Recovering from Thoracoscopy

Following a thoracoscopy may vary, with some patients recuperating in the hospital. Post-procedure care can include oxygen support and temporary drain removal. Recovery is generally faster for minimally invasive thoracoscopy compared to more invasive surgeries.

Patients who have undergone a regular thoracoscopy might have a chest tube for drainage, usually in place for one to two days. After the procedure, rest and limited activity for a week or two are typically advised.

VATS patients may receive extra oxygen and a chest tube, and they are observed in a post-anesthesia care unit. Hospitalization and observation duration may vary.

Risks and Side Effects of Thoracoscopy

A regular thoracoscopy is generally considered low-risk. Potential complications include post-procedural fever, pleural tears causing air leaks, and air trapped in tissues under the skin. Severe but rare complications may involve hemorrhage, lung perforation, and artery obstruction.

Common side effects include air in blood vessels, tissues under the skin, air leakage into the pleural space, bleeding, fever, fluid collection in the lungs, infection, low blood oxygen, low blood pressure, organ injury, pain, reactions to anesthesia, shortness of breath, and potential cancer cell spreading.

A significant concern is tumor seeding, where cancer cells may spread due to endoscopic device manipulation. To mitigate this risk, doctors may make thoracoscopic incisions in locations matching potential future surgeries for removal of seeded cancer cells.

Benefits of Thoracoscopy

Thoracoscopy offers numerous advantages for mesothelioma patients. In one study, it correctly identified pleural mesothelioma in 92% of cases. Additional benefits include minimally invasive nature, low complication rates, and potential cost savings compared to more invasive procedures.

Compared to traditional thoracotomy, thoracoscopy typically entails less pain, fewer complications, and quicker recovery. Ongoing research explores the role of thoracoscopy in early mesothelioma detection, potentially improving patient outcomes.