Obtaining a diagnosis of malignant pleural mesothelioma usually involves many tests. A definitive diagnosis is usually made after a pleural biopsy. Thoracoscopy is a procedure that allows access to the pleural space to obtain the biopsy in a less invasive way than has been done in the past.
Malignant pleural mesothelioma is a disease of the lining of the lung. It occurs between the visceral, the inner lining and the parietal, the outer layer. These are very thin layers of cells that line the lungs and chest wall. Usually a small amount of fluid, called pleural fluid, lubricates the two layers. When the fluid builds up for various different reasons, it can cause a pleural effusion to form causing shortness of breath. This is one of the common symptoms of malignant pleural mesothelioma as well as many other common illnesses.
Minimally invasive diagnostic procedures involve smaller incisions, less pain, lower risk of infection, shorter hospital admissions, quicker recovery time, less scarring, and reduced blood loss.
Thoracoscopy is a minimally invasive procedure used to diagnose and treat diseases of the pleura, the lining of the lung. The medical-dictionary thefreedictionary.com defines thoracoscopy as follows: “an insertion of an endoscope, a narrow diameter tube with a viewing mirror or camera attachment through a very small incision in the chest wall.” Other terms used to describe thoracoscopy are thoracoscopic surgery, pleuroscopy, or video assisted thoracic surgery. Depending on the suspected reason for the procedure the doctor performing the surgery could be a surgeon or a pulmonologist.
Although these terms are often used interchangeably, there are some differences. Thoracoscopy/Pleuroscopy is a procedure involving internal examination, biopsy and or resection of disease and masses within the pleural cavity and thoracic cavity. This is performed using a thoracoscope via a small incision in the chest. A thoracoscope is a thin lighted scope with a video camera. During this procedure the doctor examines the pleural cavity, the pleural lining of the visceral and parietal layers that line the outside of the lung. This procedure can also be used in connection with another procedure called a pleurodesis when fluid is drained. Video Assisted Thoracic Surgery- VATS- is a type of thoracic surgery. Using a small incision, the doctor guides a thoracoscope in the area allowing examination of the lungs, mediastinum, and pleura. Another incision might be needed for additional visualization.
A bronchoscope is usually performed only after a routine diagnostic workup is inconclusive. A routine workup usually includes blood work, chest x-rays, CT scans, and a thoracentesis. A bronchoscopy is a procedure where a lighted scope is inserted through the mouth and down to the lungs.
It is often difficult to make a final diagnosis malignant pleural mesothelioma. Thoracentesis fluid is positive for malignant pleural mesothelioma in less than 35% of cases.
Thoracoscopy can be used for other chest surgery besides obtaining biopsy samples. Wedge resections of the lungs can be performed this way. During a wedge resection a wedge-shaped portion of tissue can be removed depending on the reason for the surgery, usually for diagnosis or treatment of lung nodules.
Thoracoscopy procedures are usually done under general anesthesia. That involves having a battery of tests done before hand such as laboratory blood work, EKG, CT scan and pulmonary function tests. Pulmonary function tests are done to make sure the person can tolerate surgery. Other pre-surgical work up usually includes stopping aspirin one week before the surgery and having nothing by mouth usually from midnight before the procedure. If the doctor is unable to perform the surgery via thoracoscope, an open procedure with a larger incision will be performed. Post operatively a drain may be left in place to drain air or fluid in the space.
Thoracoscopy is a procedure that has smaller incisions, less pain during recovery, shorter hospital stays, reduced blood loss, and generally less chance of complications.
Although the language might be confusing, thoracoscopy is an improvement in the treatment of patients who need to have a pleural biopsy for diagnosis of malignant pleural mesothelioma.
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