Thoracoscopy

Introduction

Your doctor has discussed having a procedure called Thoracoscopy with you, to help find the cause of your chest symptoms, or to help your breathing.

This leaflet is for patients to explain what the procedure called Thoracoscopy is and why it is done.

What is Thoracoscopy?

Thoracoscopy involves putting a small camera into the chest through a small hole (about 2cm). This allows your doctor to look inside your chest, remove the fluid which has built up, and take samples from inside your chest to help work out what is the cause of your problems.

Why do I need this procedure?

When you take a breath in, your lung follows the inside of your rib cage as it moves, but they are not stuck together. There is a double layered covering (the pleura), rather like “cling film”, between the outer surface of the lungs and the inside of the rib cage. It is lubricated and allows the lungs to move with the rib cage when you breathe in and out. 

In your case, fluid has built up between these layers and this is limiting how much your lung can expand. This may be making you breathless. As well as the fluid, your scans may also have shown some abnormal thickening of the chest lining.

What should I do before the procedure?

You must not eat or drink for 4 hours before the test. You should still take your usual medicines with a small amount of water. If you take medicines for diabetes, your doctor will give you specific instructions about these.

If you are taking blood thinning medicines (for example, Aspirin, Clopidogrel, Dipyridamole, Ticagrelor, Warfarin, Apixaban, Rivaroxaban, Tinzaparin, Enoxaparin), your doctor will also give you specific instructions.

If you are unsure what to do, you must contact us to check.

The procedure will require at least 1 night in hospital. You should bring appropriate clothes and toiletries. If you are on medication, you will need to bring these to hospital with you.

You will be given an appointment to come to hospital 2 hours before the test. A nurse will check your blood pressure and pulse and insert a cannula (a fine tube) into a vein in your arm or the back of your hand using a small needle.  This allows blood samples to be taken and medication to be given before and during the procedure.

A doctor or nurse will explain the procedure and also confirm you have signed a consent form.

What will happen during the procedure?

The procedure takes between 40 to 60 minutes. You will be asked to lie on your side (your unaffected side). You will have an oxygen mask put on your face.  The procedure is performed in an operating theatre, with medication to make you feel comfortable, but you are not asleep. The side of your chest will be cleaned and then covered with clean sheets to protect against infection. The doctor will inject medicine to the chest to numb the area where the camera will go.

A small incision (cut) is then made in the side of your chest about 2cm in size.  You will feel some pushing, but this should not be painful and does not take long.

Through the cut, the doctor then removes fluid in the space, puts in the camera to inspect the chest appearance, and then, in most cases, takes samples of the inside lining of your chest.

If you experience pain or discomfort, you must tell the doctor who will give you extra relaxing medicine and painkillers.

At the end of the procedure the camera is removed and replaced with a small drainage tube to allow the lung to re-expand into the space where the fluid was removed. 

Sometimes we put in a small amount of special talcum powder to try and seal up the area where the fluid was produced, to prevent it re-accumulating. This is called a “talc pleurodesis” and we will explain to you if this is likely to be necessary in your particular case. 

If we do a talc pleurodesis you may have a slightly longer stay in hospital, possibly 3 or 4 days. 

What will happen after the procedure?

You will have a chest X-ray and you will return to a Respiratory Ward (24 or 25) with the tube in place attached to a drainage bottle; you may see some bubbles of air and a little blood in the bottle which is normal.

You may experience some pain or discomfort in your chest, but if this happens you must inform the nursing staff or doctor so they can give you some painkillers.

Once the lung has re-expanded (which usually takes 1 to 3 days) the tube will be removed and after a chest X-ray, you will be able to go home. There will be a small stitch in the skin which will be removed by your District Nurse or Practice Nurse 7 to 10 days after discharge.

What are the possible risks and complications?

Thoracoscopy is a safe procedure. It is not major surgery and the chances of complications are low, however it is an invasive test and so has some risks:

Bleeding

There is a small chance of causing some bleeding either when the telescope is introduced or when the biopsies are taken. This can happen to less than 5 people in every 100.¹

If this happens it can normally be stopped quite easily.  Very rarely a surgeon may need to be involved to help stop the bleeding.  This can happen to 1 person in every 1,000 cases.¹

Infection

As with any procedure there is a risk of wound infection but this is a small risk.  Any infection usually settles rapidly with antibiotics. 

Rarely there can be infection inside the chest space, a more serious complication. The risk of a serious infection is less than 1 person in every 100.¹  If this happens you will need a longer stay in hospital.

Air leak

Sometimes a hole can develop in the edge of the lung during the procedure. This usually settles without any extra treatment, but it may mean the chest tube has to stay in place until the leak settles which could be several days.

Air can also sometimes move from the chest through the hole into the skin. This makes the skin expand and develop a crackling sensation when the skin is pressed. This almost always settles in a few hours. It is very unusual for this to be a significant problem.

Failure of the lung to re-expand, ‘trapped lung’

Usually once the fluid is removed from the chest the lung will then re-expand to its normal size. Sometimes, because of the problem inside the chest, the lung cannot re-expand.

To try and help re-expand the lung, suction tubing is attached to the chest drain bottle. If the lung does not re-expand we will explain the implications of this to you.  It is not a serious problem, but it does mean the fluid is likely to build up again in the future.

Tumour growth

After a long time if cancer is present, it can spread into the procedure site. This does not happen very often, if it does, radiotherapy can be used at the site.

Failure to carry out procedure

Sometimes because of the disease in the chest it becomes too difficult to move the camera into the chest. This is rare, and usually the scans before the procedure will help us prevent this.

The samples taken during the test are usually very good at helping to diagnose the problem inside the chest, but sometimes the samples don’t answer this.

Temperature

You may develop a temperature if you have a Pleurodesis.

Contact numbers

If you develop pain which is not responding to standard painkillers or you develop increasing breathlessness in the hours after the procedure you should contact Lung Health or the GP Out of Hours service.

If you have any worries or concerns you should contact:

Department of Respiratory Medicine

Telephone: 01642 624936

Monday – Friday, 9.00am to 5.00pm

Lung Health

Telephone: 01642 624270

Monday to Friday, 9.00am to 5.00pm

Further information is available from

NHS Choices

Telephone: 111 (when it is less urgent that 999)

Calls to this number are free from landlines and mobile phones

or via the website at www.nhs.uk

British Lung Foundation

British Lung Foundation

Telephone: 03000 030 555

Monday – Friday, 9.00am to 5.00pm

or via the website at: www.blf.org.uk

Reference

1. Local anaesthetic thoracoscopy: British Thoracic Society        pleural disease guideline 2010. Thorax 2010;65 (suppl 2): ii54 – ii60

Comments, concerns, compliments or complaints

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