Thoracoscopy

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Thoracoscopy
PMC4114701 OL-08-03-1246-g01.png
Thoracoscopic views of a huge mediastinal lymphangioma before surgery.
Specialty pulmonary
ICD-9-CM 34.21
MeSH D013906
OPS-301 code 1-691.0

Thoracoscopy is a medical procedure involving internal examination, biopsy, and/or resection of disease or masses within the pleural cavity and thoracic cavity. [1] Thoracoscopy may be performed either under general anaesthesia or under sedation with local anaesthetic.

Biopsy medical test involving sampling of cells or tissues for examination

A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist involving extraction of sample cells or tissues for examination to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. An incisional biopsy or core biopsy samples a portion of the abnormal tissue without attempting to remove the entire lesion or tumor. When a sample of tissue or fluid is removed with a needle in such a way that cells are removed without preserving the histological architecture of the tissue cells, the procedure is called a needle aspiration biopsy. Biopsies are most commonly performed for insight into possible cancerous and inflammatory conditions.

Pleural cavity thin fluid-filled space between the two pulmonary pleurae (visceral and parietal) of each lung

The pleural cavity also known as the pleural space, is the thin fluid-filled space between the two pulmonary pleurae of each lung. A pleura is a serous membrane which folds back onto itself to form a two-layered membranous pleural sac. The outer pleura is attached to the chest wall, but is separated from it by the endothoracic fascia. The inner pleura covers the lungs and adjoining structures, including blood vessels, bronchi and nerves. The pleural cavity can be viewed as a potential space because the two pleurae adhere to each other under all normal conditions. Parietal pleura projects up to 2.5 cm above the junction of the middle and medial third of the clavicle

Thoracic cavity

The thoracic cavity is the chamber of the body of vertebrates that is protected by the thoracic wall. The central compartment of the thoracic cavity is the mediastinum. There are two openings of the thoracic cavity, a superior thoracic aperture known as the thoracic inlet and a lower inferior thoracic aperture known as the thoracic outlet.

Contents

History

Thoracoscopy was first performed by Sir Francis Cruise of the Mater Misericordiae Hospital in Dublin in conjunction with Dr Samuel Gordon in 1865. [2] It was further developed by Hans Christian Jacobaeus, a Swedish internist in 1910 for the treatment of tuberculous intra-thoracic adhesions. He used a cystoscope to examine the thoracic cavity, developing his technique over the next twenty years. Today, thoracoscopy is performed using specialized thoracoscopes. These instruments include a light source and a lens for viewing and may have ports through which other instruments may be inserted for the purpose of tissue removal and manipulation.

Hans Christian Jacobaeus Swedish internist

Hans Christian Jacobaeus was a Swedish internist born in Skarhult.

Sweden constitutional monarchy in Northern Europe

Sweden, officially the Kingdom of Sweden, is a Scandinavian Nordic country in Northern Europe. It borders Norway to the west and north and Finland to the east, and is connected to Denmark in the southwest by a bridge-tunnel across the Öresund Strait. At 450,295 square kilometres (173,860 sq mi), Sweden is the largest country in Northern Europe, the third-largest country in the European Union and the fifth largest country in Europe by area. The capital city is Stockholm. Sweden has a total population of 10.3 million of which 2.5 million have a foreign background. It has a low population density of 22 inhabitants per square kilometre (57/sq mi) and the highest urban concentration is in the central and southern half of the country.

Tuberculosis Infectious disease caused by the bacterium Mycobacterium tuberculosis

Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections do not have symptoms, in which case it is known as latent tuberculosis. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those affected. The classic symptoms of active TB are a chronic cough with blood-containing mucus, fever, night sweats, and weight loss. It was historically called "consumption" due to the weight loss. Infection of other organs can cause a wide range of symptoms.

Video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery (VATS) is a surgical operation involving thoracoscopy, usually performed by a thoracic surgeon using general or local/regional anaesthesia with additional sedation as necessary. It has historically also been referred to as pleuroscopy. A wide variety of diagnostic and therapeutic procedures may be performed with this technique which has become very popular and increasingly so since the early 1990s. Prior to this, limited diagnostic procedures were done using variations on the cystoscope since 1910. Advances in direct optical visualization were quickly surpassed when video cameras were attached to the endoscopes. The advent of endoscopic stapling was also a major advance so that complicated procedures such as pulmonary lobectomy could be performed safely. VATS can be useful for the diagnosis of undefined interstitial lung diseases. [3]

Video-assisted thoracoscopic surgery type of thoracic surgery performed using a small video camera that is introduced into the patients chest via small incisions

Video-assisted thoracoscopic surgery (VATS) is a type of thoracic surgery performed using a small video camera that is introduced into the patient's chest via small incisions. The surgeon is able to view the instruments that are being used along with the anatomy on which the surgeon is operating. The camera and instruments are inserted through separate holes in the chest wall also known as "ports". These small ports are advantageous because the chance for infection and wound dehiscence are drastically reduced. This allows for a faster recovery by the patient and a greater chance for the wound to heal.

Surgery Medical specialty

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas.

Interstitial lung disease group of lung diseases affecting the interstitium (the tissue and space around the air sacs of the lungs)

Interstitial lung disease (ILD), or diffuse parenchymal lung disease (DPLD), is a group of lung diseases affecting the interstitium (the tissue and space around the alveoli. It concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, and perivascular and perilymphatic tissues. It may occur when an injury to the lungs triggers an abnormal healing response. Ordinarily, the body generates just the right amount of tissue to repair damage, but in interstitial lung disease, the repair process goes awry and the tissue around the air sacs becomes scarred and thickened. This makes it more difficult for oxygen to pass into the bloodstream. The term ILD is used to distinguish these diseases from obstructive airways diseases.

See also

Cardiothoracic surgery medical specialty involved in surgical treatment of organs inside the thorax

Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thorax —generally treatment of conditions of the heart and lungs. In most countries, cardiac surgery and general thoracic surgery are separate surgical specialties; the exceptions are the United States, Australia, New Zealand, and some EU countries, such as the United Kingdom and Portugal.

Video-assisted thoracoscopic surgery (VATS) lobectomy is an approach to lung cancer surgery.

Related Research Articles

Laparoscopy procedure in which a laparoscope is inserted through a small incision near the navel to examine abdominal and pelvic organs

Laparoscopy invented by George Kelling in 1901, in Germany, is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.

Endoscopy used in medicine to examine the interior of a hollow organ or cavity of the body

An endoscopy is used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inserted directly into the organ.

Pulmonology medical specialty

Pulmonology is a medical speciality that deals with diseases involving the respiratory tract. The term is derived from the Latin word pulmō, pulmōnis ("lung") and the Greek suffix -λογία, -logia. Pulmonology is synonymous with pneumology, respirology and respiratory medicine.

Pleurodesis

Pleurodesis is a medical procedure in which the pleural space is artificially obliterated. It involves the adhesion of the two pleurae.

Thoracotomy incision into the pleural space of the chest

A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It is performed by surgeons to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine. The purpose of a thoracotomy is the first step used to facilitate thoracic surgeries including lobectomy or pneumonectomy for lung cancer or to gain thoracic access in major trauma.

Decortication is a medical procedure involving the surgical removal of the surface layer, membrane, or fibrous cover of an organ. The procedure is usually performed when the lung is covered by a thick, inelastic pleural peel restricting lung expansion. In a non-medical aspect, decortication is the removal of the bark, husk, or outer layer, or peel of an object. It may also be done in the treatment of chronic laryngitis. It is the primary treatment for fibrothorax.

Pulmonary sequestration congenital disorder of respiratory system

A pulmonary sequestration is a medical condition wherein a piece of tissue that ultimately develops into lung tissue is not attached to the pulmonary arterial blood supply, as is the case in normally developing lung. This sequestered tissue is therefore not connected to the normal bronchial airway architecture, and fails to function in, and contribute to, respiration of the organism.

Hemothorax Blood accumulation in the pleural cavity

A hemothorax is an accumulation of blood within the pleural cavity. The symptoms of a hemothorax include chest pain and difficulty breathing, while the clinical signs include reduced breath sounds on the affected side and a rapid heart rate. Hemothoraces are usually caused by an injury but may occur spontaneously: due to cancer invading the pleural cavity, as a result of a blood clotting disorder, as an unusual manifestation of endometriosis, in response to a collapsed lung, or rarely in association with other conditions.

Maximilian Nitze German urologist

Maximilian Carl-Friedrich Nitze was a German urologist born in Berlin.

Pulmonary pathology is the subspecialty of surgical pathology which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of the lungs and thoracic pleura. Diagnostic specimens are often obtained via bronchoscopic transbronchial biopsy, CT-guided percutaneous biopsy, or video-assisted thoracic surgery (VATS). The diagnosis of inflammatory or fibrotic diseases of the lungs is considered by many pathologists to be particularly challenging.

Lobectomy of the lung is a surgical operation where a lobe of the lung is removed. It is done to remove a portion of diseased lung, such as early stage lung cancer.

Cardiothoracic anesthesiology is a subspeciality of the medical practice of anesthesiology, devoted to the preoperative, intraoperative, and postoperative care of adult and pediatric patients undergoing cardiothoracic surgery and related invasive procedures.

Raja Michael Flores, M.D., is an American thoracic surgeon, currently Chief of the Division of Thoracic Surgery at Mount Sinai Hospital and Ames Professor of Cardiothoracic Surgery at the Icahn School of Medicine at Mount Sinai, both in New York City.

Trimethylene carbonate or 1,3-propylene carbonate is a 6-membered cyclic carbonate ester. It is a colourless solid that upon heating or catalytic ring-opening converts to the poly(trimethylene carbonate). Such polymers are called aliphatic polycarbonates are of interest for potential biomedical applications. An isomeric derivative is propylene carbonate, a colourless liquid that does not spontaneously polymerize.

Arvind Kumar (surgeon) Indian surgeon

Arvind Kumar is the Chairman, Center for Chest Surgery and Director, Institute of Robotic Surgery at Sir Ganga Ram Hospital (SGRH) New Delhi and Founder & Managing Trustee, Lung Care Foundation. He is Former Professor of Surgery & Head of Thoracic & Robotic Surgery Unit, All India Institute of Medical Sciences (AIIMS), New Delhi (1988-2012).

Lung biopsy

A lung biopsy is an interventional procedure performed to diagnose lung pathology by obtaining a small piece of lung which is examined under a microscope. Beyond microscopic examination for cellular morphology and architecture, special stains and cultures can be performed on the tissue obtained.

Interventional pulmonology is a maturing medical sub-specialty from its parent specialty of pulmonary medicine. It deals specifically with minimally invasive endoscopic and percutaneous procedures for diagnosis and treatment of neoplastic as well as non-neoplastic diseases of the airways, lungs, and pleura. Many IP procedures constitute efficacious yet less invasive alternatives to thoracic surgery.

References

  1. " thoracoscopy " at Dorland's Medical Dictionary
  2. Clinical Reports of Rare Cases, occurring in the Whitworth and Harwicke Hospitals. By Samuel Gordon. Dublin Quarterly Journal of Medical Science Feb 1, 1866
  3. Luo, Q; Han, Q; Chen, X; Xie, J; Wu, L; Chen, R (2013). "The diagnosis efficacy and safety of video-assisted thoracoscopy surgery (VATS) in undefined interstitial lung diseases: A retrospective study". Journal of Thoracic Disease. 5 (3): 283–8. doi:10.3978/j.issn.2072-1439.2013.04.12. PMC   3698278 . PMID   23825760.