When is a thoracoscopy/thoracoscopic surgery indicated?

Thoracoscopy or thoracoscopic surgery is indicated when there is a need to diagnose or treat conditions in the chest cavity. Some common indications for thoracoscopy include:

• Repair congenital abnormalities such as oesophageal atresia, congenital diaphragmatic hernias and diaphragmatic eventrations.
• Resect congenital cystic adenomatoid malformations (CCAM), congenital lobar emphysema and bronchopulmonary dysplastic lesions (BPD).
• Biopsy: When a sample of tissue is needed to diagnose a suspected cancer or other condition in the chest cavity, a thoracoscopy may be used to obtain a biopsy.
• Pleural effusion: When fluid accumulates in the pleural space (the cavity between the lung and the chest wall), thoracoscopy can be used to drain the fluid and investigate the cause of the effusion.
• Pneumothorax: A collapsed lung due to air leaking into the pleural space can be treated with thoracoscopy to insert a chest tube and remove the air.
• Lung nodules: Thoracoscopy can be used to obtain a biopsy of a small lung nodule that is difficult to reach with traditional surgical methods.
• Lung cancer: Thoracoscopy can be used to diagnose and stage lung cancer and, in some cases, to remove small tumours.
• Mediastinal tumours: Tumours located in the mediastinum (the space between the lungs) can be removed using thoracoscopy.

The decision to perform a thoracoscopy will depend on the individual patient's condition and the extent of the suspected or confirmed chest pathology. The procedure is typically performed by a thoracic surgeon who will evaluate the patient and determine the most appropriate course of action.

How is a thoracoscopy/thoracoscopic surgery performed?

Thoracoscopy, or thoracoscopic surgery, is a minimally invasive procedure that is typically performed under general anaesthesia. Here is a general overview of how the procedure is performed:

• The patient is placed in a lateral position (lying on their side) with their arm raised on the side to be operated on.
• Small incisions, typically less than 1cm in length, are made in the chest wall between the ribs. The number of incisions and their location will depend on the reason for the thoracoscopy.
• A thoracoscope, a slender, adaptable tube comprising a camera and light at the tip, is inserted through one of the incisions. This allows the surgeon to see inside the chest cavity on a monitor.
• Additional surgical instruments are introduced through the other incisions to perform procedures that may include obtaining a tissue sample, excising a tumour, or draining fluid.
• After the completion of the procedure, the instruments are taken out, and the incisions are closed using sutures or sterile strips.
• A chest tube may be inserted through one of the incisions to drain any remaining fluid or air.
• The patient is moved to the recovery room and carefully observed until they recover from the effects of the anaesthesia.

The approximate time of the procedure will depend on the reason for the thoracoscopy and the complexity of the case. Most patients are able to go home within a few days after the procedure, and the recovery time is typically shorter than with traditional open chest surgery.

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