Sometimes the cause of a chest problem can’t be found even after X-rays, CT scans and fluid tests. This is especially common with pleural effusion, a collection of fluid around the lungs, where repeated fluid tests may still not show whether the cause is tuberculosis, cancer or something else. In such cases, medical thoracoscopy (also called pleuroscopy) lets the doctor look directly inside the chest and take biopsies, without major surgery. In this video, Dr. Dipak Viradia, Chest Physician & Interventional Pulmonologist, explains this procedure.

What Is Medical Thoracoscopy?

The lungs are covered by a thin double layer called the pleura. In medical thoracoscopy, a thin telescope with a camera (thoracoscope) is passed into the space between these layers through a small cut of about 1–2 cm in the side of the chest. The doctor can directly see the pleura and the lung surface on a screen, drain fluid, and take biopsies from the exact abnormal areas.

A flexi-rigid pleuroscope combines the strength of a rigid scope with a flexible tip, allowing the doctor to reach different parts of the pleural space more easily.

When Is Thoracoscopy Needed?

• Pleural effusion (fluid around the lung) of unknown cause, when fluid tests haven’t given an answer
• Suspected tuberculosis of the pleura, which is common in India and where fluid tests are often inconclusive
• Suspected cancer of the pleura or cancer spread to the pleura, including mesothelioma
• Recurrent fluid build-up, especially due to cancer, where pleurodesis (sealing the pleural layers with medicine such as talc) can prevent fluid from returning
• Evaluation of certain cases of chest trauma or pneumothorax (air around the lung)

How It Differs from Surgery

Medical thoracoscopy is performed by an interventional pulmonologist, usually under local anaesthesia with sedation, through a single small cut. Surgical thoracoscopy (VATS) is performed by a thoracic surgeon under general anaesthesia, usually through multiple cuts. For many patients needing diagnosis of pleural effusion, medical thoracoscopy provides the answer with a smaller procedure and quicker recovery.

What Happens During the Procedure

1. Preparation: an ultrasound is done to locate the fluid and choose the safest entry point. Tell your doctor about blood thinners and other medicines.
2. Anaesthesia: local anaesthesia numbs the area, and sedation keeps you relaxed and comfortable.
3. The procedure: through a small cut, the thoracoscope is inserted. Fluid is drained, the pleura is examined, and biopsies are taken. If needed, pleurodesis is done at the same time. It usually takes 30–60 minutes.
4. After the procedure: a small chest tube is usually placed to drain remaining fluid or air, and is removed once drainage settles. The hospital stay is generally short.
5. Results: biopsy results usually come in a few days.

Benefits

• Direct view of the inside of the chest
• High diagnostic accuracy for pleural effusion, because biopsies are taken from visibly abnormal areas
• Diagnosis and treatment in one procedure: biopsy, fluid drainage and pleurodesis together
• No major surgery, with a small cut and faster recovery

Is It Safe?

Medical thoracoscopy is safe when performed by an experienced team. Possible side effects include pain at the cut site, mild fever, minor bleeding, air leak, or infection, which are usually manageable. Your doctor will assess whether the procedure is suitable for you based on your scans and overall health.

Dr. Dipak Viradia
Chest Physician & Intensivist | Interventional Pulmonologist & ECMO Specialist
Rudrax Chest Clinic, 301, Solaris Royce, Opp. Old RTO, Athwagate, Ring Road, Surat – 395001
Appointment: +91 75676 19985
Website: www.drdipakviradia.com