32651 Thoracoscopy, surgical; with partial pulmonary decortication

Name of the Procedure:

Thoracoscopy, surgical; with partial pulmonary decortication

Summary

Thoracoscopy with partial pulmonary decortication is a minimally invasive surgical procedure to remove fibrous tissue from the surface of the lung. This prevents further lung restriction and restores proper lung function. The procedure involves making small incisions and using a thoracoscope (a thin, flexible tube with a camera) to perform the surgery.

Purpose

This procedure addresses conditions where fibrous tissue encases the lung, such as pleural empyema or scar tissue from previous infections. The goals are to remove restrictive tissue, allowing the lung to expand fully, improve breathing, and decrease discomfort.

Indications

• Chronic pleural empyema (pus in the pleural cavity)
• Significant pleural thickening or scarring after infections
• Unresolved lung infections
• Persistent or recurrent pleural effusions

Preparation

• Fasting for at least 8 hours before the procedure
• Adjusting current medications as directed by the healthcare provider
• Undergoing preoperative diagnostic tests such as chest X-rays, CT scans, or pulmonary function tests

Procedure Description

1. Patient is given general anesthesia.
2. Small incisions are made in the chest for inserting the thoracoscope and surgical instruments.
3. The thoracoscope provides a visual guide while the surgeon removes the fibrous tissue from the lung surface.
4. Additional instruments may be used to decorticate or remove the thickened pleural lining.
5. The procedure is completed by closing the incisions and placing any necessary drainage tubes.

Duration

Typically, 2 to 4 hours depending on the extent of decortication needed.

Setting

Performed in a hospital operating room.

Personnel

• Thoracic surgeon
• Surgical nurse
• Anesthesiologist
• Operating room technician

Risks and Complications

• Bleeding
• Infection
• Air leaks from the lung
• Persistent pleural effusion
• Anesthesia-related complications
• Rare potential for incomplete lung expansion

Benefits

• Improved lung expansion and function
• Relief from symptoms such as breathlessness
• Decreased risk of recurrent infections
• Most patients experience benefits within a few weeks post-surgery

Recovery

• Hospital stay of 3 to 7 days to monitor recovery
• Post-procedure pain management, often involving medications
• Instructions to avoid heavy lifting and strenuous activities for several weeks
• Follow-up appointments to monitor lung function and healing

Alternatives

• Antibiotic therapy for less severe cases
• Chest tube drainage for pleural effusions
• Open thoracotomy for more extensive disease
• Each alternative has specific benefits and risks compared to thoracoscopy, and the best option depends on the individual patient's condition.

Patient Experience

• During the procedure, the patient will be under general anesthesia and feel no pain.
• Post-procedure discomfort is common and managed with pain medication.
• Some patients may experience temporary reduced lung function during initial recovery.
• Full recovery can take several weeks, with gradual improvements in breathing and activity level.