Undiagnosed pleural effusion
When fluid analysis after a chest tap has not given an answer, direct biopsy usually does.
Pleural procedures · Coimbatore
Thoracoscopy in Coimbatore
When there is fluid around the lung and the cause is still uncertain, looking directly at the pleura and taking a biopsy is the most reliable way to get an answer.
Medically reviewed by Dr. Arun Gangadhar, MBBS, DNB (Pulmonary Medicine), MNAMS, IDCCM, EDARM — Consultant Interventional Pulmonologist & Sleep Physician, Sri Ramakrishna Hospital and Lung Care — The Pulmonary Clinic, Coimbatore.
Overview
What medical thoracoscopy is
A pulmonologist-led, day-care alternative to surgical biopsy for pleural disease, done through a single small opening under local anaesthesia and sedation.
Flexi-rigid thoracoscopy and pleural intervention are part of the routine practice of Dr. Arun Gangadhar, Consultant Interventional Pulmonologist at Sri Ramakrishna Hospital, Coimbatore, who earlier introduced semi-rigid thoracoscopy for pleural disease in Thrissur district.
Not every effusion needs thoracoscopy. Many are diagnosed with a simple ultrasound-guided tap and fluid analysis; thoracoscopy is reserved for cases that remain unexplained or that need drainage and pleurodesis together.
Applications
Pleural conditions it helps with
Suspected tuberculous pleurisy
Pleural biopsy for histology and culture, which is more reliable than fluid testing alone.
Malignant pleural disease
Diagnosis, staging support, and talc pleurodesis or an indwelling pleural catheter for recurrent effusion.
Empyema and loculated fluid
Breaking down loculations and placing a drain under direct vision in selected patients.
What to expect
Preparation, the procedure and recovery
Before
Ultrasound of the chest, blood counts and clotting, fasting, and a consent discussion about what is being looked for.
During
Local anaesthesia with sedation, a single small entry point, inspection of the pleura, fluid drainage and biopsies.
After
A chest drain for a day or two while the lung re-expands, with pain relief and a short inpatient stay.
Results
Pathology and microbiology reports in about a week, then a treatment plan explained at follow-up.
Questions
Thoracoscopy — common questions
What is medical thoracoscopy?
Medical thoracoscopy, also called pleuroscopy, is a day-care procedure in which a thin telescope is passed through a small opening in the chest wall to look directly at the pleura — the lining of the lung — drain fluid and take biopsies under vision.
Why would a pulmonologist advise thoracoscopy?
Most often when there is fluid around the lung whose cause is still unclear after a chest tap, or when tuberculous or malignant pleural disease needs a tissue diagnosis. It also allows drainage and pleurodesis in the same sitting.
How is it different from surgery?
Medical thoracoscopy is performed by a pulmonologist under local anaesthesia with sedation, through a single small opening, rather than under general anaesthesia in an operating theatre. Some complex cases still need surgical (VATS) management.
What does recovery involve?
A chest drain usually stays in for a day or two while the lung re-expands, so a short hospital stay is common. Discomfort at the site settles within a few days.
What are the risks?
It is generally safe in experienced hands. Uncommon risks include pain at the site, bleeding, air leak, infection and a lung that is slow to re-expand. These are discussed with you before consent.