Thoracoscopy

For the first time, diagnostic thoracoscopy became known in 1910 thanks to the Swedish pulmonologist Hans Jacobeus.

The pulmonologist decided to use a cystoscope to diagnose the pleural cavity of his patients who suffered from tuberculosis. Somewhat later, the doctor designed an optical apparatus, which was given the name thoracoscope.

During the first three years of the device's existence, 89 diagnostic procedures were recorded.

Over the years, the device has been improved, a galvanocauter (an instrument with which tissue was cauterized) was attached to it. G. Jacobeus in his practice actively used the device both for diagnostics and for cauterization of pleural adhesions.

It is worth noting that already in 1925, a pulmonologist for the first time in history performed the first targeted biopsy of pleural tissues in a patient suffering from mesothelioma.

Modern devices are equipped with video cameras with a color image, which operate on high-resolution microcircuits, which allow transmitting the received image to the monitor. Thanks to new changes in the thoracoscope, the devices can now be used not only for diagnostic purposes, but also for operations (everything that is displayed on the monitor can be seen by all doctors and assistants involved in the operation).

The concept of diagnosis

Thoracoscopy (videothoracoscopy, pleuroscopy) is an endoscopic technique that is used to examine the patient's pleural cavity by introducing a thoracoscope through a neat puncture of the chest wall.

A clear color image, which is displayed on the monitor, allows the specialist to assess the condition of all the examined organs: pericardium, mediastinum and lungs.

The procedure is carried out exclusively in the conditions of specialized medical institutions. Can fulfill the therapeutic and diagnostic purpose, allows the doctor to determine the exact diagnosis.

Surgeons often use diagnostics as a substitute for thoracotomy, an operation that involves opening the chest.

Advantages of thoracoscopy

Among all the positive aspects of thoracoscopy, it is worth noting that after the procedure there are practically no scars left (only a small one from a puncture), the duration of rehabilitation is minimal, and there is no need transfer the patient to the intensive care unit. In addition, the period of hospitalization of the patient is reduced, as the likelihood of postoperative complications is reduced.

The procedure is short and requires minimal anesthesia. And thanks to modern techniques and technologies, it is performed as accurately as possible.

The procedure is intended to:

  • perform an atypical pulmonary marginal resection;
  • pumping fluid from the pleural cavity;
  • removal from lung subpleural cysts;
  • performing a biopsy;
  • diagnosing diseases of the pleura.

Indications and contraindications

The basis for the procedure is the presence of a number of diseases in which thoracoscopy is the only diagnostic method.

Damage to the lymphatic system in the form of the formation of mediastinal lymphoma. Thoracoscopy is the only diagnostic method that makes it possible to obtain morphological samples for a variety of immunohistochemical studies. The results of the research will accurately determine the type of disease and its stage.

Exudative pleurisy of unclear etiology. Pleurisy is a disease that can form due to various reasons. Diagnostics will allow obtaining biopsy material to establish an accurate diagnosis and the cause of the onset of the disease.

Penetrating wounds of the chest - the procedure allows to exclude or determine damage to the organs of the mediastinum and pericardium.

Peripheral lung cancers - thoracoscopy can help determine the location of the cancer and take biopsy material for further examination.

Mediastinal lymphadenopathy - a large number of inflamed lymph nodes are localized in the mediastinum. Diagnosis through a thoracoscope will allow you to determine the types of lesions and take a tissue sample for analysis. Only the results of the analysis can accurately determine the type of disease and its origin.

The procedure is contraindicated in the presence of intraperitoneal bleeding, purulent formations and accumulations in the chest area, the general serious condition of the patient, cerebral circulation disorders, adhesive processes in the pleura, hemorrhagic diathesis, hemopericardium, acute pulmonary heart failure, coagulopathy.

Preparation for diagnosis

Since there are many contraindications for the procedure, the patient is usually referred for spirometry, a coagulogram, an electrocardiogram, and a chest x-ray before a thoracoscopy.

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All test results will show the presence or absence of contraindications for the procedure.

During the preparation of the patient for thoracoscopy, the doctor should establish the presence / absence of an allergic reaction in the patient to a number of drugs. Before the procedure, the patient signs a written agreement himself or a close relative can do this.

The doctor is obliged to give the patient a full explanation of the whole essence of the forthcoming procedure. The patient is warned that the thoracoscopy is performed under general anesthesia, that in the process a drain will be installed in the chest. A reassuring conversation is held regarding the minimal risks of complications after the study. The patient is informed that 12 hours before the procedure it is forbidden to eat food.

The duration of the procedure depends on various factors, in particular whether a biopsy or endoscopic type of surgery is performed. On average, a diagnostic procedure can take anywhere from 60 minutes to 2 hours, while a surgical procedure can take 3 hours.