What is video thoracoscopy?

Video-assisted thoracoscopy is one of the methods most used by pulmonologists and thoracic surgeons. We tell you about its characteristics.

Last update: 25 February, 2022

Each of the medical specialists uses some tools to assess patients in the best possible way. For those dealing with chest diseases, especially respiratory diseases, video-assisted thoracoscopy is an option.

It is a relatively safe procedure that consists of inserting tubes into the chest to diagnose and treat diseases. If you are interested in knowing a little more, then we will talk about its main characteristics.

Overview of video-assisted thoracoscopy

Video-assisted thoracoscopy is a type of minimally invasive surgery that allows diagnosing and treating conditions that affect the organs of the rib cage. It is performed by pulmonologists or thoracic surgeons and consists of inserting an apparatus between the two layers of the pleural cavity (the visceral and the parietal pleura).

According to a publication in the Chilean Journal of Surgery, its origin dates back to the beginning of the 20th century in Sweden. Physician Hans Christiansen Jacobaeus made the first explorations in the chest cavity to evaluate patients with tuberculosis; moment from which this technique became popular in Europe.

It is currently considered a safe and very useful method for assessing patients with pathologies that affect the chest. Especially those reserved for the respiratory system.



Indications

As mentioned, video-assisted thoracoscopy allows doctors to diagnose and treat various diseases. Some of them are mentioned below:

  • Lung cancer: It is one of the main causes of morbidity and mortality associated with cancer worldwide. According to a research article, video-assisted thoracoscopy is performed to comprehensively explore tumor lesions and objectively assess the possibility of resection.
  • Pneumothorax: This condition is characterized by the presence of air within the pleural cavity, which normally contains a small amount of fluid. There are many types of pneumothorax, this technique being useful in those patients with relapses. In these cases, a pleurodesis is usually performed, that is, the obliteration of the pleural space to prevent accumulation of fluid.
  • Pulmonary nodule: When lesions in the form of small masses are found inside the lungs by techniques such as chest computed tomography (CT), it is necessary to take a sample. Video-assisted thoracoscopy allows this in certain cases.
  • Biopsies: In any case where malignancy is suspected, it is necessary to take a tissue sample to diagnose it in the laboratory. As with digestive endoscopy, video-assisted thoracoscopy is the most recommended method due to its safety and cost.
A suspicious sign of malignancy in the lung merits complementation with a video-assisted thoracoscopy.

Contraindications

Despite its excellent safety profile, not all patients are candidates for video-assisted thoracoscopy. Here are some of the most common contraindications for this procedure:

  • Pleural symphysis: that is, when the two layers that define the pleural space are already joined by previous procedures.
  • Respiratory insufficiency: In patients with severely compromised lung function, video-assisted thoracoscopy could hinder ventilation processes.
  • Contralateral pneumonectomy: If a patient is missing one of their lungs (ie it was removed during a previous pneumonectomy), they are highly likely to develop complications during the procedure in the only lung they have.


video-assisted thoracoscopy technique

We will divide the technique into 3 fundamental phases: preparation, procedure and recovery. Let’s see.

1. Preparation

As in most cases it is an outpatient and planned procedure, the treating physician must be informed of all the treatments that are being received. This is important, as the use of anticoagulants could increase the risk of complications.

Video-assisted thoracoscopy should be performed in an operating room or appropriate space to prevent contamination of used equipment. That is, to reduce the risk of infections. Both the health personnel and the patient must dress or cover themselves with specific disposable material.

Many hospital centers recommend hospitalization at night or the previous hours. A fasting period of approximately 8 to 12 hours should be guaranteed.

2. Procedure

The most common position in which the patient should be placed is lateral decubitus (ie sideways). After administering local or general anesthesia (which will depend on the extent of the procedure and the medical criteria), the specialist will make some incisions in the chest wall.

After that, it will introduce tubes with built-in tools for tissue resection, biopsy taking, etc. Also, one of the tubes will have a tiny video camera attached to a monitor.

The space to perform the procedure must comply with biosafety parameters.

3. Recovery

Once the procedure is completed, the surgeon will remove the devices and proceed to close the wounds. The patient will need to spend some time in the recovery room while waiting for the effects of anesthesia to wear off. The collected samples will be sent to the laboratory.

In some cases hospitalization is necessary for 1-3 days to monitor recovery. Especially in those patients with a higher risk of complications.

A useful technique for pulmonology

As you have seen, video-assisted thoracoscopy is a relatively simple and very useful technique. It has become the preferred tool of many professionalsthanks to its effectiveness as a diagnostic and therapeutic method.

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