Thoracoscopy

Before your thoracoscopy

Be sure your doctor knows about any medicines you are taking, including vitamins, herbs, and supplements, as well as if you have allergies to any medicines.

You might be asked to stop taking blood-thinning medicines, including aspirin, for several days before the test to reduce your risk of bleeding. Your doctor might also ask you to adjust or stop other medicines as well, such as those for diabetes. If you normally take prescription medicines in the morning, talk with your doctor or nurse about how to manage them on the day of your test.

You will likely be asked not to eat or drink anything for at least several hours before the procedure. Your doctor or nurse will give you specific instructions. Be sure to follow them and to ask questions if you don’t understand something.

Making a transportation plan

Because a sedative is used to help keep you more comfortable during the procedure, you will need to arrange for a ride home after the test.

You might be sleepy or dizzy and need someone to help you get safely into your home, so a cab or rideshare service might not be a good option. Some centers will not allow you to use a cab or rideshare after this procedure.

If transportation or help getting home might be a problem, talk with your health care provider. There might be other resources available, depending on the situation.

During your thoracoscopy

How your thoracoscopy is done will depend on where the procedure is done and the type of anesthesia used.

Outpatient procedure: This means you don’t need to stay overnight in a hospital. It is done in a procedure room using local anesthesia, to numb the insertion area, and a sedative to help you relax and reduce pain without putting you fully to sleep. Most non-surgical thoracoscopies are done this way.

Inpatient procedure: This means you do need to stay in the hospital overnight or for a few days. It is done in the operating room under general anesthesia, where you are fully asleep and will feel no pain. This is used for more complex procedures.

The process

Your doctor will review the procedure with you and ask you to sign a consent form. For this test, you’ll change into a hospital gown and lie on your side on a table.Your blood pressure, heart rate, and breathing will be monitored.

If done as an outpatient procedure, you will be given a sedative through an intravenous (IV) line to help you relax and local anesthesia.

If being done as an inpatient procedure, you will be under general anesthesia for the test.

A breathing tube might be placed through your mouth or nose, into your trachea (windpipe), and connected to a machine.

A small cut is made in your back just below the tip of the shoulder blade between your ribs. This is where the thoracoscope is inserted and passed into your chest cavity. Sometimes, another small cut is made on the same side just below the underarm to allow for insertion of a cutting tool or other device.

If VATS is being performed, you might have other cuts to allow multiple tools to be used. Air might be released from the lung on that side to help the doctor see any abnormal areas.

If abnormal areas are seen, the doctor will remove them with the cutting tool and send them to be checked in the lab.

If fluid needs to be drained, another cut is made in the lower chest wall where a flexible catheter (chest tube) is inserted to drain fluid over a few days. When finished, the lung will be re-expanded, the thoracoscope and cutting tool(s) will be removed, and the cuts closed. If you had a breathing tube placed, it will be removed.

The procedure can take between 30 and 90 minutes, but might longer depending on what’s being done.

After your thoracoscopy

After the procedure, you will be watched closely for any problems. As the anesthesia wears off, you might be groggy or confused for a few hours.

If you had the procedure as an outpatient, you should be able to go home after a few hours. Someone will need to drive you home and stay with you until the sedative wears off. Your doctor or nurse should give you specific instructions to follow after the test, including when to start taking medicines again that might have been stopped for the procedure.

If you had the procedure done as an inpatient under general anesthesia, you will most likely stay in the hospital a few days. If you had a chest tube placed to drain fluid, it will be stitched in place and might be attached to a drainage bag or device. It might be removed in a few days after the draining has stopped.

Your mouth and throat will likely be numb afterwards, so you won't be allowed to eat or drink right away. Once the numbness wears off, you might have a sore throat, cough, or hoarseness for a day or so, especially if you had a breathing tube.

You might have pain or numbness in the sites where the cuts were made.

If biopsies were taken, results are usually ready within a few days, although some tests might take longer. You will need to follow up with your doctor after the procedure to get your results.

Possible risks of thoracoscopy

Thoracoscopy is usually safe, but there is a small risk of certain complications:

Bleeding: If a biopsy were done, a small amount of bleeding could happen where the doctor removed tissue samples.

Fever: This is common after the procedure as a result of inflammation. It is usually not a sign of infection.

Needing to have a thoracotomy: A thoracotomy opens the chest cavity with a larger cut. This may be needed if the procedure could not be done with the smaller cut used by thoracoscopy.

Pneumothorax (collapse of part of a lung): This is rare but can happen after a biopsy or from pressure in the airways during the procedure.

Infection: In rare cases, the cuts can get infected or you could get a lung infection (pneumonia).

Drug reactions: Sometimes the drugs used to help you relax and stay comfortable during the test can cause changes in blood pressure, confusion, dizziness, trouble breathing on your own, or even an allergic reaction. You will be watched closely for any medicine side effects and they will be treated, if needed.

Your doctor might order a chest x-ray after the thoracoscopy to check for pneumothorax or other lung problems. Some problems might go away on their own, but if they’re causing symptoms, such as trouble breathing, they might need to be treated.

Before you go home, your doctor or nurse should give you specific instructions on when you might need to call the doctor’s office for problems. In general, these include:

• Coughing up small amounts of blood
• Cough that is persistent
• Fever that doesn’t go away
• Redness, swelling, pain, or drainage along the incision site(s)
• Severe sore throat
• Vomiting
• Wheezing that is unusual for you

Call 911 or go to the emergency room if you have:

• Chest pain or pressure that is increasing
• Trouble breathing (new)
• Coughing up large amounts of blood

Be sure you understand what you should watch out for, the possible timing of when problems might occur, and when you should call for problems.