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Posted On Dec 02, 2022
Consultant - Interventional Pulmonologist
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Pulmonologist use to thoracoscopy diagnose and observe health-related issues within the lungs and other organs of the chest. A thoracoscope is used for taking samples of lung tissues and lymph nodes. It is used as an alternative to invasive surgery in order to treat multiple issues without undergoing any larger incisions.
Diseases related to pleura have affected the vast majority of people across the globe. Thoracoscopy is a common procedure to examine the surface of the lungs and the region around the lungs, known as the pleural space. The healthcare provider uses a thoracoscope consisting of a thin camera with light for visualizing the regions around the lungs and taking samples of lung tissues and lymph nodes, diaphragm, esophagus, chest wall, and other regions.
Thoracoscopy is used for various surgical procedures of the chest and is used as an alternative to open thoracotomy for accessing the thorax. Two different types of thoracoscopy are used, involving medical thoracoscopy (MT) and video-assisted thoracoscopic surgery (VATS). The procedures are discussed below:
It can be performed by both general surgeons and internists by using local anaesthesia and some premedication. The pleural spaces of the patients are diagnosed using ultrasound immediately before the procedure. Radiographic imaging is performed to select the appropriate site for thoracoscope introduction. The location of insertion is chosen to prevent low insertion sites and any harm caused to the diaphragm and intra-abdominal organs.
The interventional pulmnologist in Vijayawada remove 500 ml of fluid from the pleural space through thoracentesis and induce pneumothorax before inserting a trochar. The pulmonologist can also make an intercostal incision, which allows fluid for aspiration after the insertion of the trochar. A single skin incision is made within the 5th to 7th intercoastal space within the lateral chest wall of the hemithorax in case of malignancy. Pleural biopsies are taken after the evacuation of pleural fluid. An incision in the fourth intercostal space is preferred if the procedure is done to see blebs and bullae in the lung apex. Although a double-puncture approach is occasionally used, a single-puncture technique is typically used for medical thoracoscopy. Using a rigid or semi-rigid pleuroscope, the pulmonologist can see into the pleural space in both cases. Only the posterior and mediastinal sides of the lung cannot be seen once the pleural cavity has been accessed, allowing for practically total vision of the parietal cavity.
The procedure of VATS is usually carried out using general anesthesia. The requirement of an experienced anaesthesia team in open thoracic procedures and single lung ventilation is considered important. VATS is carried out using lumen intubation, which is preferred by most surgeons, or single lumen intubation. Single lumen intubation is used during pleural effusion and parietal pleural biopsy. VATS is also performed with sedation and local anesthesia.
In this thoracoscopy procedure in Vijayawada, patients are placed on the operating table and their chest is prepared and draped to undergo thoracotomy. General anaesthesia is given to the patient and, after its administration, the insertion of a thoracoscope, which collapses the ipsilateral lung for optimal visualisation of the intrathoracic structures. The detailed analysis of the thoracic cavity is done and exploration of the plural cavity is completed using direct thoracoscopic visualization which allows access to intercostal space. The minor procedure involves three different incisions of 1 cm for ports that integrate the triangulation of the instruments, one involving a camera being placed in the central port and the other two being integrated for biopsy and retraction instruments. In the event that there is a necessity for undergoing an open thoracotomy, the incisions are joined. A chest tube is placed within the pleural space at the end of the procedure. Depending upon the complexity of the treatment and situations, the patient needs to spend 2-3 hours in surgery and remain in the hospital for a few days after undergoing VATS.
After the thoracoscopy, the patient may feel numbness in the mouth and throat. The breathing tube makes the patient hoarse, resulting in a sore throat after the thoracoscopy procedure. Little pain is observed near the region of incisions. The tube is placed for at least two days after the thoracoscopy in case the surgeon performed biopsies or drained fluid.
Dr. Gutta Lokesh
Manipal Hospitals, Vijayawada
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