Thoracoscopy | Diseases and conditions: Medical tests.

What is the thoracoscopy

The thoracoscopy is a surgical technique that allows to visualize directly inside the rib cage, either to study the lungs and other organs of its interior, or to carry out treatments and surgeries. For this small incisuras are made with a scalpel into the chest wall, and endoscopes are introduced through them with cameras, clamps, and other small devices that allow you to manipulate internal organs without having to open all of the rib cage.
The thoracoscopy was first described in 1910 by Jacobaeus, a Professor of medicine at Stockholm, he demonstrated its use for the treatment of sequelae of tuberculosis. For 40 years it was only used for that, but gradually more uses were discovered, and currently has practical use in many diseases of the lung. In 1980 they began to design specific instruments that allowed the taking of samples for biopsy and also to intervene directly in the organs of the inside of the chest cavity. At the end of the 1980s were designed video cameras that were adapted to the endoscopes; Thus arose the VATS (video-assisted thoracic surgery).
He is considered to as a surgery technique thoracoscopy minimally invasive (same as arthroscopy, laparoscopy, or Ercp). However, continuing to treat is surgery, which should be performed in an operating room under general anesthesia and a thoracic surgeon. Since a few years it has begun to divide the thoracoscopy between "health" and "surgical". The first could be performed by Thoracic Surgeons or pulmonologists, to treat disorders of tuberculosis or other diseases under local anesthesia, while the second only Thoracic Surgeons perform it to perform complex techniques under general anesthesia.
Techniques minimally invasive as the thoracoscopy have allowed that postoperative patients is less painful, short and more satisfactory. Not having to take so many pills for the pain and reduce time in hospitals cost saving is very important. It also decreases the number of infections in the postoperative period because the invasion toward the inside of the rib cage with small incisions, surgical wounds are minimal.

When a thoracoscopy is performed

But the thoracoscopy can be used for diagnostic purposes (view the lungs directly, biopsy), its most important use is based on surgical interventions, which every day are more advanced. Most frequent situations in which it is used are:
Take biopsies of tumors not studied.
Collapse the chest cavity to avoid that you fill with liquid (serum, pus, blood, etc). This is known as pleurodesis.
Remove Lung Tumors, as solitary pulmonary nodules.
Treat the collapsed lung tissue (atelectasis).
Extract blood, clots, or artifacts that are around the lung after an accident.
Remove Caverns of tuberculosis to re-expand the lung.
Clean lesions, local accumulations of pus.

Preparation for the thoracoscopy

If you will perform a thoracoscopy , these are issues that must be considered:
Duration: the thoracoscopy has a very different duration according to the surgical technique to be performed. It can last from hours (removal of blood or pus) to a whole morning or afternoon (surgery of Lung Tumors).
Income: the thoracoscopy usually requires hospital admission from the night before the operation. Then the postoperative period can be extended about three or four days, if all goes well will not be more than one week. If the thoracoscopy has only been for biopsy you can receive discharge within 24 hours.
Is necessary to be accompanied?: Yes, is recommended. After the thoracoscopy efforts should not be and you may need help to go to the bathroom or merge. When you receive the high is not recommended that you drive for the next 24 hours, at least.
Drugs: don't need to take any prior medication. You should tell your doctor all the medicines taken regularly and will decide which suspend or maintain. You should avoid taking medications that hamper the clotting of blood two weeks prior to the thoracoscopy, such as aspirin, ibuprofen, and other anti-inflammatory drugs.
Food: must remain in fasting 8 hours before the thoracoscopy. If you need to take any medication, take the pills with a small SIP of water.
Clothing: once he enters the hospital you will put a gown more comfortable and suitable for the operating room. Clothing is recommended for sleep and comfortable footwear for the entry.
Documents: it is recommended to take the medical history that described the disease is going to intervene, although the doctor will already have it with him. Before you undergo the intervention you will sign the informed consent with which you agree to make yourself the technique and you will know the potential risks.
Pregnancy and breast-feeding: the thoracoscopy should be limited to the second trimester of pregnancy and only where necessary, only in urgent situations. There is nothing that contraindicated the thoracoscopy during lactation, although the postoperative period and the hospital admission may hinder proper breastfeeding.
Contraindications: the main contraindication is having an once in a lifetime a pleurodesis has collapsed the thoracic cavity and not allowing its opening. Other contraindications are acute respiratory failure, advanced heart failure, problems with clotting, or active infection. Smoking is a contraindication in many cases of chronic smokers because it hinders the postoperative and compromises the good progress after surgery.

How the thoracoscopy

First, you will be mentioned in the consultation of the thoracic surgeon, who will assess the disease or alteration which you present and if a candidate to submit to a thoracoscopy. Perform you a physical exam and ask you some questions. It is important that you communicate if you smoke, and if so you will have to abandon the tobacco several weeks before surgery. In this consultation, they will tell you what medications you can take.
When you arrive at the hospital the day of surgery you will pass to the ante-room to the operating room, where you anestesiarán so that you don't feel any pain throughout the procedure. Anesthesia is almost always general, so you'll be asleep and you will not remember nothing after; in a few cases, this is done under local anesthesia . The chest wall is then disinfected and covered with a surgical sheet with which the area of the chest is involved is limited. You must normally placed side, with an arm raised up to gain access to the rib cage comfortably.
The surgeon will make three incisuras in the abdominal wall that will introduce the camera, the gas that inflate inside the rib cage, and other instruments such as tweezers or scalpels. Before that, the lung to operate side will deflate and the air passage will not be allowed inside. The camera allows to observe the inside of the chest, and gas that is introduced is carbon dioxide, as in laparoscopy.
Once inside, the surgeon will study and explore well the lungs, pleura, and associated nodes. The technique to perform will be planned before the surgery, but is often to during the change of opinion to identify findings that have gone unnoticed in computed tomography or magnetic resonance. During surgery the main surgeon will be assisted by at least another surgeon more, and a nurse who will give you the necessary material. The anaesthetist will be at all times in the operating room to your vital signs are good.
The intervention is recorded on video so the surgeon can get back to see her, and also so that others can learn. If it is necessary to remove a piece of the inside of the chest you can put in plastic bags that are then removed through a larger incisura. This is how solitary pulmonary nodules removed or extensive lung resections are made. So nodes suspect have metastasis or infections are caught.
When the intervention ends, all instruments are removed and the incisions are closed with simple points that cover with bandages or dressings. Always leave a tube that serves as a drain of possible internal bleeding or inflammatory interstitial fluid.

Complications of the thoracoscopy

The thoracoscopy is a safe and widely used technique today, but it is not without risk, as in all surgical operations. The most common complications are:
  • Bleeding through the incisions or inside the cavity of the thorax.
  • Pulmonary thromboembolism by clots that travel to the lungs of the legs.
  • In the postoperative surgical wound infections; Preoperative antibiotic prevents them to a large extent.
  • Damage during the operation of arteries, veins or bronchial tree.
  • Problems caused by general anaesthesia (allergies, respiratory problems).
  • Difficulty the lung expands, by accumulation of blood (hemothorax) or air (pneumothorax).
  • Pneumonia.

Results of the thoracoscopy

The thoracoscopy recovery is much quicker, less painful and more satisfying than when operating the chest open with a wide incision directly (Thoracotomy).
When you wake up from the anesthesia it will be drowsy, and you can have nausea. You will pass to the area of awakening, where you remain in observation several minutes to verify that anesthesia is no longer have an effect. A few hours stop feel as well, and you'll be more awake and active.
You will then send admitted plant, where you'll be a few days recovering you. Drains leave them posts until does not collect any liquid. Also likely chest incisions to painful, especially to make efforts as coughing, it is therefore advisable to take painkillers that you will tell the doctor. If you do not cough with normal you can accumulate mucus secretions that form eventually pneumonia.
If a diagnostic thoracoscopy doctor you can communicate your result shortly after completing it, but sometimes you have to wait for the analysis of biological samples such as biopsies, which can take several weeks to be analyzed.
A few days later you cite in the hospital or outpatient to check abdominal incisions to heal properly. In this meeting they discussed you also the results of the operation, and you can ask details about your illness. If everything is OK you can this type of surgery is sufficient and is not necessary to follow other treatment.
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