Medical thoracoscopy (pleuroscopy): Equipment, procedure, and complications
- Francis D Sheski, MD
Francis D Sheski, MD
- Associate Professor of Clinical Medicine
- Indiana University School of Medicine
Thoracoscopy (pleuroscopy) involves passage of an endoscope through the chest wall for direct visualization of the pleura. Medical thoracoscopy is most commonly used for pleural fluid drainage, pleural biopsy, and pleurodesis. Although the equipment and some applications are similar to those used in video-assisted thoracoscopic surgery (VATS), it is typically more limited in its diagnostic and therapeutic functions and performed by pulmonologists, thus the term "medical" thoracoscopy.
The technique, instruments used, and complications of medical thoracoscopy are reviewed here. The diagnostic and therapeutic uses are discussed separately. (See "Medical thoracoscopy (pleuroscopy): Diagnostic and therapeutic applications".)
Rigid and semirigid thoracoscopes are commonly used; choosing among them is typically operator-dependent.
Rigid instruments — The rigid thoracoscope is probably still the most common instrument used for medical thoracoscopy. It is cheap and provides both excellent optical quality and maneuverability within the pleural space [1-5]. Multiple diameter and angle-viewing instruments are available :
●Most instruments contain a light source, working channel, and video port all in a single device, allowing for a single point of entry procedure. Other instruments fulfill just one of these needs which necessitates a multi-port procedure. (See 'Choosing a point of entry' below.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Rigid instruments
- Semi-rigid instruments
- - Flexible fiberoptic instruments
- - Autofluorescent instruments
- - Three dimensional instruments
- Choosing a point of entry
- - Local anesthesia plus procedural sedation
- - General anesthesia
- Intercostal dissection and lung deflation
- Sedation or anesthesia-related
- SUMMARY AND RECOMMENDATIONS