Page 45 - World Association of Laparoscopic Surgeons - Journal

10.5005/jp-journals-10007-1141
Atul Soni et al
ORIGINAL RESEARCH
The Role of Thoracoscopy in Diagnosis and

Treatment of Pleural Disease

Atul Soni, Vandana Bansal, Amitabh Goel

ABSTRACT alternative approach for sympathectomy for upper extremity
hyperhidrosis, sympathetic dystrophy and Raynaud’s
Intrathoracic disease involving lungs and pleura encountered
frequently and remains a challenging clinical problem. phenomenon. 3 Good short-term results are reported for
4
The definitive diagnosis of lung or pleural disease some times achalasia via thoracoscopic esophagomyotomy. Indeed, the
remain unclear despite thoracocentesis, closed pleural biopsy, indications for VATS continue to evolve. 3-6
transthoracic needle aspiration or bronchoscopy. Recent
advances in endoscopic technique, video equipment and Although thoracoscopy is used for such procedures,
development of better instrumentation have contributed to the adequate controlled trials confirming its superiority to
resurgence of thoracoscopy as a diagnostic and thoracoscopic conventional open thoracotomy are lacking. Its evaluation
modality.
has been based on performance in selected patients by
Keywords: Malignancy, Needle biopsy, Pleural disease, experienced operators. In this review, we discribed the
Thoracoscopy, Tumor.
thoracoscopy’s technique, advantages, disadvantages,
How to cite this article: Soni A, Bansal V, Goel A. The Role of diagnostic utility, therapeutic and operative applications,
Thoracoscopy in Diagnosis and Treatment of Pleural Disease
complications and controversies.
World J Lap Surg 2012;5(1):4-15.
Finally, a few thoughts about future directions of this
Source of support: Nil emerging technology are shared.
Conflict of interest: None declared
PROCEDURE DETAILS
INTRODUCTION
Simple rigid thoracoscopy (without video assistance) must
Thoracoscopic surgery of the chest using a simple rigid be differentiated from VATS (with video assistance). Simple
scope was first described in terms of its original concept in rigid thoracoscopy is the use of a metal, illuminated scope
1
1910 by Dr Jacobaeus, a Swedish internist. It proved to be placed into the pleural space for the purpose of diagnosing
safe and diagnostically accurate. Its major use subsequently pleural disease or performing minor therapeutic maneuvers
was in the era of collapse therapy with lysis of such as pleurodesis. Video equipment is not used. Operators
pleuropulmonary adhesions for tuberculosis treatment. 2 can use a lighted mediastinoscope, thoracoscope, or
With the development of antituberculous drugs in the late laparoscope. The mediastinoscope offers a large working
1940s, thoracoscopy was all but abandoned except for channel and provides for excellent visualization of the
diagnosing pleural disease. In 1970, Dr Joe Miller, Jr, at pleural space. Simple rigid thoracoscopy can be performed
the Emory Clinic, began to match changes in technology under local anesthesia in an endoscopy suite or under general
with clinical applications and the thoracoscopy has anesthesia in an operating room.
reemerged as an alternative approach to open thoracotomy For simple rigid thoracoscopy, the patient is prepared
in the management of chest disease. Minimally invasive and draped in the lateral position with the affected side
thoracic surgery allows the performance of surgical upward. The entry point is usually between the third and
procedures in the chest cavity utilizing small incisions and sixth intercostal space along the midaxillary line, depending
specially-adapted, video-endoscopic instruments. This on the indication.
affords a quicker and less painful convalescence for the Video-assisted thoracoscopic surgery (VATS) primarily
patient. Many procedures which were previously performed used by thoracic surgeons, VATS is a surgical technique
with larger incisions can now be done thoracoscopically, used to potentially minimize the morbidity of an open
with comparable results. Thoracoscopy is useful for the procedure.
diagnosis and treatment of a variety of intrathoracic The thoracoscope consists of a slender fiberoptic tube
processes, such as for solitary pulmonary nodule resection, that can be inserted into a 1/2 inch incision in the chest.
metastatic resections, open lung biopsies, pericardiectomies, The image is then combined with a tiny telescopic lens, a
pneumothorax repair, resection of small mediastinal tumors; powerful light source, and a small video camera and is
lung-volume reduction for pulmonary emphysema and projected onto a TV screen. The surgeon can literally see
pleural space drainage procedures. It has become an into the chest. Then using graspers, endoscopic scissors and

4
JAYPEE